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The give and take of blood banking.

A month from now, retired Air Force Staff Sgt. Dennis Provencher will make his way to the American Red Cross Center on Camp Foster in Okinawa to donate yet another pint of his blood. In 2004, Guinness World Records recognized him as having donated more blood than anybody else. "I challenge anyone to catch me," he told Stars and Stripes on Feb. 12. (1)

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As with all blood donations, Provencher's is separated into packed red blood cells, fresh frozen plasma, and platelets--any unit of which could technically save someone's life. He enlisted in the Air Force in 1951 in his home state of New Hampshire, and has donated blood since his transfer to Okinawa in 1961. A radio operator during his service, Provencher says he fell in love with the island and its people; he extended his assignment long enough to retire there in 1971. (1)

According to the American Red Cross, if a person begins donating blood at age 17 and donates every 56 days until he reaches 76, he will have donated 48 gallons of blood, potentially helping save more than 1,000 lives. (2) At 76, Provencher has given 34 gallons of blood in the last 46 years. He is one of a small band of long-term blood donors. (1)

An Ohio man, Alan Whitney, makes a habit of donating platelets and is now working his way across the country to get the word out that others, too, should donate. Whitney undertook his goal to donate in all 50 states, starting in Pennsylvania in 2007; and on Feb. 10, Oregon was his 35th. He sat in a chair to donate platelets for the 647th time at age 71, having been a volunteer in blood banks in one form or another for the past 45 years. (3)

Would-be donors banned

While these "feel-good" stories of regular and even enthusiastic donors give the impression that America has no donor problems, nothing could be further from the truth. Out of its estimated 309 million citizens, the United States had only 9.5 million donors in 2006. (2) While approximately 37% of the U.S. population is eligible to give blood, only 5% actually donate, while the number of transfusions nationwide increases by 9% every year. (2), (4)

In the world of blood-donor collection, certain people are denied from time to time, or permanently, the opportunity to give blood. Despite technological advances and the precautions to ensure a safe blood supply, for example, federal policy permanently denies homosexual men, intravenous drug users, or anyone who has been paid for sex from donating blood. The Food and Drug Administration (FDA)--the organization responsible for federally regulating the blood supply--adopted the policy in 1983 to reduce the risk of transmitting HIV/AIDS via blood transfusion. (4) Among other blood-related organizations, the American Red Cross has denounced the ban, calling it "medically and scientifically unwarranted because all donated blood has undergone testing since 2007." (5)

At the University of South Dakota (USD), blood drives have been a joint operation with the Siouxland Community Bank and the Sioux Falls Community Blood Bank. During the 2008-2009 school year, USD donated 628 units of blood, but members of the campus 10% Society complained that the policy is not fair since, in the words of a freshman student, "For this ban to make sense, it would have to be a ban of all sexually active people and even then, there is a chance of failure." San Jose State University announced in 2008 that the FDA policy violated the school's non-discrimination policy regarding sexual orientation, thus, there would be no more school-sponsored blood drives. Several other universities have followed suit. (5) The FDA has not changed its rules; and from time to time cites the fact that it would if given data that showed doing so would not pose a "significant and preventable" risk to blood recipients. (6)

Diseases that preclude donation

Other groups are also banned from donating blood, such as those whose blood may carry diseases other than HIV/AIDS. In years past, blood donors discovered to have hepatitis B antibodies were warned that a second positive test result would disallow their continued participation. Perhaps 200,000 Americans have been banned from giving blood because of repeated false-positive tests for hepatitis B, according to the FDA. In the late 1980s and the 1990s, as many as 21,500 Americans were turned away every year because of false-positive hepatitis B tests, but the FDA proposed allowing some people who initially test positive for hepatitis B to donate. A new test for hepatitis B is much more specific. People who test positive on the first test could be tested again eight weeks later with the more specific test. If that test is negative, they would be allowed to donate blood. (7)

The United States also banned blood donations from people who spent six months or more cumulatively in Britain between 1980 and 1996. The ban was employed when speculation spread that a British man who received blood in 1997 and developed variant Creutzfeldt-Jakob Disease (vCJD or "mad cow disease") six years later may have contracted it from an infected transfusion. (8) Despite little evidence at the time that new variant Creutzfeldt-Jakob Disease might be transmitted by blood or plasma, an FDA advisory panel voted in 1999 to prohibit donations from that category of people. (9) vCJD transmission via blood transfusion was finally confirmed in 2003.

Cutaneous Leishmaniasis or L Major was a concern during large-scale 1990 and 1991 U.S. military operations in Saudi Arabia, Kuwait, and Iraq and was, at one time, listed by the U.S. Army Medical Research and Development Command as a possible health threat to U.S. troops in Somalia. Persian Gulf veterans were banned from donating blood in the early 1990s. The fear that Leishmania tropica, a parasite transmitted by sand flea (Phlebotomus papatasi) bites, could be spread through transfusions, prompted a 14-month ban for these veterans, beginning Nov. 12, 1991. (10)

In 2003, the World Health Organization diagnosed more than 200,000 citizens of Kabul, Afghanistan, with Cutaneous Leishmaniasis. Late that year, the FDA held a blood-banking seminar to discuss the possibility of contamination of the U.S. blood supply by Leishmaniasis. It was there that the FDA decided a lifetime ban on blood donations from persons from Iraq diagnosed with Leishmaniasis should be imposed, because there is no guarantee of a 100% sterile cure of any version of Leishmaniasis. Later, the Pentagon made the same policy for U.S. troops. (11)

The recession finds a drop in blood donations

The American Red Cross says the number one reason donors say they give blood is because they want to help others; the two most common reasons cited by people who do not give blood are they never thought about it or they do not like needles. (2) During the past year, blood donations have fallen low enough to prompt directors of various blood banks to tap into national stockpiles through the busy spring season. Florida is one example. Because of the recession, blood drives at Florida businesses--normally suppliers of approximately 40% of the blood used at local hospitals--have dropped substantially. Many businesses have closed or had substantial layoffs. Those that have not closed have fewer employees left to donate. (12)

Florida's blood shortages are linked to the recession, even though the nation's blood supply remains adequate. In some areas of the state where seasonal visitors to RV parks are recruited for blood drives, previous donors have not made the annual trek to the Sunshine State because of the economy. Some Florida blood banks are now making trips to high schools where ad campaigns encourage younger donors, since state law allows students as young as 16 to give blood. Currently, teens make up 10% of the state's blood supply. (12)

Facts about blood donation

According to the American Red Cross, type O-negative blood (red cells) can be transfused to patients of all blood types; it is always in great demand and often in short supply. Only 7% of people in the U.S. have O-negative blood type. Type AB-positive plasma can be transfused to patients of all other blood types; AB plasma is also usually in short supply, since only 3% of people in the U.S. have the AB-positive blood type. The blood used in an emergency is already on the shelves before the event occurs. (2) Statistics show that 25% or more of us will require blood at least once in our lifetime. (4)

The upside to regular blood donation includes a mini-physical with each visit to the blood bank. Many blood banks offer childcare, on-site bloodmobiles, or convenient parking. Whole blood donation only takes approximately 45 to 60 minutes. (4) Donating blood is a safe, simple four-step process: registration, medical history and mini-physical, donation, and refreshments. A sterile needle is used only once for each donor and then discarded. (2) Because there is a lag time after exposure before infectious-disease tests become positive, all donors are also questioned closely about possible recent exposure to infectious diseases. (11) After blood is drawn, it is tested for ABO group (blood type) and RH type (positive or negative), as well as for any unexpected red blood cell antibodies that may cause problems for the recipient. Screening tests are also performed for:

* hepatitis B surface antigen (HBsAg);

* hepatitis B core antibody (anti-HBc);

* hepatitis C virus antibody (anti-HCV);

* HIV-1 and HIV-2 antibody (anti-HIV-1 and anti-HIV-2);

* HTLV-I and HTLV-II antibody (anti-HTLV-I and anti-HTLV-II);

* serologic test for syphilis;

* nucleic-acid amplification testing (NAT) for HIV-1 and HCV;

* NAT for West Nile virus (WNV) (this test is not required by the FDA); and

* anitbody test for Trypanosoma cruzi, the agent of Chagas' disease (this test is also not required by FDA). (13)

The Red Cross' fact sheet cites statistics that more than hint at the importance of volunteer donors: Every two seconds someone in the U. S. needs blood, and more than 38,000 blood donations are needed every day. More than 80,000 sickle-cell patients can require blood transfusions throughout their lives. More than 1 million people are diagnosed with cancer each year, many of whom need blood during chemotherapy treatments. A single car-accident victim can require as many as 100 pints of blood. (2) The Centers for Disease Control and Prevention says the U.S. blood supply is the safest in the world. But blood cannot be manufactured--it can only come from generous donors. (2)

References

(1.) Orr M. Retired airman on Okinawa holds Guinness World Record in blood donation. Stars and Stripes. February 13, 2010: http://www.stripes.com/article.asp?section=104&article=67978. Accessed February 15, 2010

(2.) American Red Cross. Blood Facts and Statistics. http://www.redcrossblood.org/learn-about-blood/blood-facts-and-statistics. Accessed February 15,2010.

(3.) Hintze H. Ohio Man Donates Blood Platelets in 35 States. KEZI.C0M 24/7 Nonstop News. http://kezi.com/healthwatch/162190. Accessed February 15, 2010.

(4.) Mayo Clinic. Did You Know? http://www.mayoclinic.org/donate-blood-rst/know.html. Accessed February 15, 2010.

(5.) Goetzinger N. Gay men still banned from giving blood. Volante Verve. February 10, 2010. http://www.volanteonline.com/verve/gay-men-stillbanned-from-giving-blood-1.2146337. Accessed February 15, 2010.

(6.) The Associated Press. FDA says gay men still can't donate blood. http://www.msnbc.msn.com/id/18827137/print/1/displaymode/1098. Accessed February 15, 2010.

(7.) USA TODAY staff. A better life: Morning rounds: Giving blood, discriminating against fat people. http://blogs.usatoday.com/betterlife/2008/05/nearly-15-of-bl.html.

(8.) Ault A. FDA bans UK blood donation. Nature Medicine. 5;720(1999). doi:10.1038/10429

(9.) Food & Drug Administration. http://www.fda.gov/BiologicsBloodVaccines/BloodBlood/QuestionsaboutBlood/DonatingBlood/default.htm. Accessed February 15, 2010.

(10.) Gunby P. Desert Storm Veterans Now May Donate Blood; Others Call for Discussion of Donor Tests. JAMA. 1993;269(4):451-452.

(11.) Leishmaniasis in Iraq from the Gulf War to OIF. http://www.gulflink.org/Leishmaniasis/leish.htm. Accessed February 15, 2010.

(12.) Scott A. Drop in blood donors linked to recession. February 1, 2010. Sarasota Herald-Tribune. P. 1.

(13.) AABB. Blood Donation FAQs. http://www.aabb.org/Content/Donate_Blood/Blood_Donation_FAQs/Accessed February 15, 2010.

RELATED ARTICLE: BLOOD BANKING

Walking blood banks: screening blood in the battlefield

By Col. Francisco J. Rentas, Maj. David A. Lincoln, Lt. Cmdr. Corey R. Jenkins, Lt. Col. Robert J. O'Connell, and Maj. Robert G. Gates

Care for severely injured combat casualties relies heavily on blood product transfusion. (1-3) Fresh whole blood (FWB) has been used in many military conflicts to resuscitate casualties. Its use in civilian settings is limited due to the wide availability of fractionated components derived from whole blood and provided for specific indications. In combat, blood requirements may exhaust pre-screened component therapy supplies, and in other cases, needed components may be unavailable at a particular location. (4) In these settings, FWB may be the only source of blood components available for the management of hemorrhagic shock and its associated coagulopathy in casualties. The physician practice of collecting and transfusing FWB supports hemostatic-resuscitation techniques performed in concert with aggressive surgical control of bleeding. This is a clinical decision usually made in the middle of a mass casualty.

Current and evolving trauma doctrine emphasizes broad distribution of medical assets to allow rapid initiation of damage-control resuscitation and surgery. (5) There is little doubt that the proximity of emergency care to casualties has contributed favorably to low combat-fatality rates during the current conflicts in Iraq and Afghanistan. (6) Geographic dispersal, however, adds to the already challenging, immense, and intermittent demands that may prevent adequate provision of blood components which have been pre-screened for transfusion-transmitted disease (TTD) pathogens in accordance with the U.S. Food and Drug Administration (FDA)-approved standard of care.

When there are not enough properly screened blood products available to care for casualties arriving at military treatment facilities during combat, U.S. military doctrine allows the use of unscreened (by U.S. FDA standards), voluntarily donated, and freshly collected blood products to save patient lives. Donors for emergency blood collections are usually military members who are co-located with the medical unit at the time of need, more commonly referred to as "the walking blood bank."

Current Clinical Practice Guidelines in Iraq and Afghanistan, clearly state that it is not appropriate to use FWB as an alternative to more stringently controlled blood products for patients who do not have severe, immediate life-threatening injuries. Fresh whole blood is to be used only when other blood products are unable to be delivered at a rate to sustain the resuscitation of an actively bleeding patient, when specific stored blood components are not available (e.g., pRBCs, platelets, Cryo, FFP) or when stored components are not adequately resuscitating a patient with an immediate life-threatening injury.

Since the need for FWB cannot be predicted, a contingency operational plan is developed by the medical staff to include the laboratory/blood bank, and surgical and anesthesia providers. If practical, a pre-screened donor pool using the blood donation questionnaire and pre-testing for all required FDA transfusion-transmitted disease markers is performed. The safest donor candidate is one with recent laboratory confirmation of blood group/type and no evidence of TTD.

In addition, where feasible, on-site testing of potential blood donors using rapid screening assays for infectious diseases (i.e., HIV, HBV, and HCV) is performed before FWB is transfused. Regardless of whether rapid testing is performed pre- or post-transfusion, these tests are not licensed for donor screening, and samples must be sent to a reference laboratory for FDA-approved blood-donor testing. A mechanism is in place to ensure both the recipient and donor can be notified should the results be positive for infectious disease. In fact, all U.S. recipients of FWB in theater are required to be tested initially and at three, six, and 12 months after transfusion according to current policy.

In an emergency, ABO/Rh of donors may be established via local testing or previous donor history. Identification tags ("dog tags") for ABO/Rh verification should be utilized as a last resort only. Retrospective testing for infectious-disease markers is performed on all donor specimens. This testing is completed at an FDA-approved, Department of Defense-sanctioned laboratory in accordance with FDA and AABB standards. In addition, several countermeasures are required of potential blood donors of blood products collected in theater in the U.S. military. These include HIV force screening of all military personnel every two years, HIV theater-entrance screening 90 days prior to deployment, and compulsory hepatitis B vaccination.

The use of FWB has been independently associated with improved survival of patients and will continue to have a place in combat-casualty care. (7) Current TTD countermeasures and risk-mitigation strategies will continue to be evaluated for improvement. This includes continued evaluation of quick and effective rapid-test methodologies that are sensitive, specific and, hopefully, FDA-approved for donor testing in the future.

Col. Francisco J. Rentas, Maj. David A. Lincoln, and Lt. Cmdr. Corey R. Jenkins, are located at the Armed Services Blood Program Office in Falls Church, VA. Lt. Col. Robert J. O'Connell is with the Department of Retrovirology at Walter Reed Army Institute of Research in Rockville, MD, and Maj. Robert G. Gates is located at the Dwight D. Eisenhower Army Medical Center in Augusta, GA.

References

(1.) Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med. 2008;36:S267-274.

(2.) Blackbourne LH. Combat damage control surgery. Crit Care Med. 2008;36:S304-310.

(3.) Perkins JG, Cap AP, Weiss BM, Reid TJ, Bolan CD. Massive transfusion and nonsurgical hemostatic agents. Crit Care Med. 2008;36:S325-339.

(4.) Kauvar DS, Holcomb JB, Norris GC, Hess JR. Fresh whole blood transfusion: a controversial military practice. J Trauma. 2006;61:181-184.

(5.) Burris DG, Rich NM, Sturtz DL Surgical research at the Uniformed Services University: one graduate's perspective--from student to Chief, Division of Surgical Research. Mil Med. 2004;169:97-101.

(6.) Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system development in a theater of war: Experiences from Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2006;61:1366-1372; discussion 72-73.

(7.) Spinella PC, Perkins JG, Grathwohl, KW, Beekley, AC, Holcomb, JB. Warm Fresh Whole Blood Is Independently Associated With Improved Survival for Patients With Combat-Related Traumatic Injuries. J Trauma. 2009;66:S69-76.

RELATED ARTICLE: Blood timeline

c. 500 BCE: Alcmaeon, Croton, Greece, observes when he dissects animals that arteries and veins are dissimilar.

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c. 400 BCE: Hippocrates suggests the body is comprised of four humors: blood, phlegm, black bile, yellow bile. Further, imbalance among the four humors causes disease. Hippocrates and his followers set out principles forming the basis of much of Western medicine, including physicians' adherence to a strict ethical code of conduct.

c. 350 BCE: Aristotle believes that the heart is the central organ of the body and--based on his dissections of different animals--a three-chambered organ, even in humans.

300 BCE: Herophilus of Chalcedon, one of the first Greek anatomists to publicly dissect human cadavers, determines arteries are thicker than veins and carry blood.

c. 130-200 BCE: Galen [Claudius Galenus], one of the most important and influential physicians next to Hippocrates, dissects and experiments on animals, proving arteries contain blood. Galen suggests that arteries and veins are completely distinct. His ideas form the core of the medical canon for centuries.

mid-1200s: Ibn al-Nafis, physician and author from Cairo, Egypt, discovers and describes the flow of blood to and from the lungs: pulmonary circulation.

1553: Spanish physician and theologian Michael Servetus refutes Galen's theory by suggesting blood flows from one side of the heart to the other via the lungs instead of through the wall between the ventricles.

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1628: British physician William Harvey publishes Anatomical Treatise on the Movement of the Heart and Blood in Animals; he explains that blood circulates within the body and is pumped by the heart.

1658: Jan Swammerdam, a 21-year-old Dutch microscopist, is thought to be the first person to observe and describe red blood cells.

1661: Italian anatomist Marcello Malpighi observes through a rudimentary microscope, the capillary system.

1665: Richard Lower in England performs the first recorded blood transfusion in animals. With a crude syringe of goose quill and bladder, he connects the jugular vein of a dog he has bled to the neck artery of second dog, resuscitating the former.

1667: In June, French physician Jean-Baptiste Denis transfuses a teenage boy suffering from a persistent fever with nine ounces of lamb's blood. He attaches the lamb's carotid artery to a vein in the boy's forearm, without the patient suffering any negative consequences. He uses the

procedure on several other patients, until Antoine Mauroy, dies after two transfusions of calf's blood in December. In 1668, Denis sues Mauroy's widow for slandering his reputation. In 1670, the case prompts the French Parliament's ban on all transfusions involving humans. In England and Rome, similar actions are taken.

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1667: Before the Royal Society in England, Drs. Richard Lower and Edmund King give Arthur Coga, an indigent former cleric, a transfusion of several ounces of sheep's blood for a fee of 20 shillings; the patient recovers nicely.

1674: Unaware Swammerdam and Malpighi, Anton van Leeuwenhoek, a Dutch linen-draper-turned-microscopist, provides a more precise description of red blood cells, approximating their size to 25,000 times smaller than a fine grain of sand.

1771: In Experimental Enquiry into the Properties of the Blood, British anatomist William Hewson details his research on blood coagulation. He succeeded at arresting clotting and isolating a substance from plasma he called "coagulable lymph," now known as fibrogen, a key protein in the clotting process.

1795: A footnote in a medical journal credits Philadelphia physician Philip Syng Physick for performing the first human-to-human blood transfusion.

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1881: British obstetrician and physiologist James Blundell performs the first recorded human-to-human blood transfusion. Using a syringe, he injects a patient suffering from internal bleeding with 12 to 14 ounces of blood from several donors. The patient dies after initially showing improvement.

1874: Sir William Osier observes small cell fragments from bone marrow make up the bulk of clots formed in blood vessels; these will come to be called platelets.

1901: Austrian physician Karl Landsteiner publishes a paper detailing his discovery of the three main human blood groups: A, B, and C (he later changes C to 0). He charts the regular pattern of reaction that occurs when he mingles the serum and red cells of an initial set of six blood specimens. Red cells agglutinate when serum from group A is mixed with the red cells of a second group B. Similarly, group B serum causes the red cells of group A to agglutinate, but the red cells of a third group C never clump when mixed with the serum of group A or B. Based on these results, he deduces that two different types of antibodies exist to cause agglutination, one in group A, another in group B, and both together in group C.

1902: Alfred von Decastello and Adriano Sturli (Landsteiner's colleagues) identify fourth blood group: AB that causes agglutination in red cells of groups A and B.

1907: Dr. Ludvig Hektoen of Chicago recommends checking the blood of donors and recipients for signs of incompatibility (or cross matching) prior to transfusion. At Mount Sinai Hospital in New York, Dr. Reuben Ottenberg performs the first transfusion using cross matching and, over the next several years, successfully uses the procedure in 128 cases, virtually eliminating transfusion reactions.

1914: Almost simultaneously, Albert Hustin of Brussels and Luis Agote of Buenos Aires discover that adding sodium citrate to blood will prevent it from clotting.

1915: Dr. Richard Lewisohn at Mount Sinai Hospital in New York formulates the optimum concentration of sodium citrate that can be mixed with donor blood to prevent coagulation but pose no danger to the recipient:.2%. Dr. Richard Weil determines that citrated blood can be refrigerated and stored for a few days and then successfully transfused.

1916: At the Rockefeller Institute in New York, Francis Peyton Rous and J.R. Turner develop a citrate-glucose solution that allows blood to be stored for a few weeks after collection and still remain viable for transfusion.

1917: While serving in the U.S. Army, Dr. Oswald Robertson, familiar with the work of Drs. Rous and Turner, collects and stores type O blood with citrate-glucose solution in advance of the arrival of casualties during the Battle of Cambrai in World War I. Thereby, he establishes the first blood depot.

1922: Percy Lane Oliver begins operating a blood-donor service out of his home in London. He recruits volunteers who agree to be on 24-hour call and to travel to local hospitals to give blood as the need arises. Volunteers are screened for disease, tested for blood type; names are entered into phone logs, so volunteers can be quickly contacted when blood is required.

1930: On March 23, at the Sklifosovsky Institute in Moscow, Dr. Serge Yudin is the first to test the efficacy of transfusing humans with cadaver blood. He successfully resuscitates a young man slashed both his wrists attempting suicide by injecting him with 420 cc of blood from a cadaver of a 60-year-old man, who died after being hit by an omnibus. The Soviets are the first to establish a network of facilities to collect and store blood for use in transfusions at hospitals.

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1935: Anesthesiologists at Mayo Clinic in Rochester, MN, organized a transfusion service in 1933 and are now the first to store citrated blood and utilize it for transfusions within a hospital setting in the U.S.

1936: In August during the Spanish Civil War, Physician Federico Duran-Jorda establishes the Barcelona Blood-Transfusion Service. The service collects blood, tests it, pools it by blood group, preserves and stores it in bottles under refrigeration, and with vehicles fitted with refrigerators, transports it to frontline hospitals. At the same time, Canadian surgeon Dr. Norman Bethune, a volunteer with the Republican Army, organizes a similar mobile blood service in Madrid: The Spanish-Canadian Blood Transfusion Institute.

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1937: Dr. Bernard Fantus coins the term "blood bank" to describe the blood donation, collection, and preservation facility he starts as director of Therapeutics at Cook County Hospital in Chicago, IL.

1939: Drs. Philip Levine and R.E. Stetson uncover an unknown antibody in the blood of a woman who has given birth to a stillborn, and postulate that a factor in the fetus' blood, inherited from the father, triggers the antibody production in the mother.

1940: Drs. Karl Landsteiner and Alex Wiener discover the Rh blood group, through experiments with the red blood cells of Rhesus monkeys, and identify the antibody found by Levine and Steston to be anti-Rh. Meanwhile, a plasma shortage in Britain during World War II prompts the U.S. to organize the Plasma of Britain campaign, run by Dr. Charles Drew from a central laboratory at Presbyterian Hospital in New York. Building on techniques already developed to separate and preserve blood plasma, which is a viable substitute for whole blood, Dr. Drew devises a modern and highly sterile system to process, test, and store plasma for shipment overseas by the Red Cross. At the same time, searching for a durable substitute for liquid plasma, Harvard biochemist Edwin Cohn invents a method to separate out its different proteins or fractions. In a series of steps that are repeated, with slight variations in temperature and chemical conditions, plasma is mixed with the solvent ethyl alcohol and centrifuged. Through this process dubbed fractionation, Cohn and his team are able to isolate the plasma components fibrinogen (Fraction I), gamma globulin (Fraction II and III), and albumin (Fraction V). Each of these fractions are thought to contain different therapeutic properties, with albumin holding the most promise.

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1941: In January, at the behest of the Surgeon General of the U.S. Army and Navy, the American Red Cross agrees to organize a civilian blood donor service to collect blood plasma for the war effort. The first center opens in New York on February 4, and the Red Cross collects over 13 million units of blood over the course of the war. Philadelphia surgeon Dr. Isidor Ravdin successfully treats victims of the Pearl Harbor attack with albumin to increase blood volume.

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1943: In his report in the Journal of the American Medical Association, Dr. Paul Beeson links the occurrence of jaundice in seven cases to blood or plasma transfusions the patients receive a few months prior, providing the quintessential description of transfusion-transmitted hepatitis.

1947: As an alternative to the Red Cross blood centers being set up across the country in the post-war period, directors of independent, community blood banks join together to form a national network of blood banks called the American Association of Blood Banks.

1948: Dr. Carl W. Walter, a trained surgeon, develops a plastic bag for the collection of blood which revolutionizes blood collection. Glass bottles--fragile and susceptible to contamination--prompted him to devise a stronger, more portable plastic container.

1959: Through the use of X-ray crystallography, in which X-rays are beamed on crystals to reveal the distribution of their atoms, Dr. Max Perutz working at Cambridge University, England, is able to unravel the structure of hemoglobin, the protein within red blood cells that carries oxygen.

1965: Dr. Judith Pool, an American physiologist at Stanford University, discovers that slowly thawed frozen plasma yields deposits high in Factor VIII (or Antihemophilic Factor). The deposits called cryoprecipitates (or cryo) are found to have much greater clotting power than plasma and given to hemophiliacs to stop bleeding episodes. It prevents the need for hemophiliacs to travel to the hospital to be treated, since cyro can be kept frozen at home and infused, after being thawed, by a physician.

late-1960s: Drs. Kenneth M. Brinkhous of the University of North Carolina at Chapel Hill and Edward Shanbrom of Hyland Laboratories produce a highly concentrated form of Factor VIII by pooling large quantities of plasma that generate vast amounts of cyro, which are then redissolved, treated, filtered, and centrifuged. The resulting powder's clotting power is 100 times stronger than raw plasma, easily stored in a portable vial, and can be injected with a syringe by hemophilia patient.

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1971: Dr. Baruch Blumberg of the National Institutes of Health (NIH) identifies a substance on the surface of the hepatitis B virus that triggers the production of antibodies. His work leads to the development of a test to detect the presence of hepatitis B antibodies, thereby identifying infected donors; the test is mandated by the FDA.

1981: The first cases of a syndrome initially called Gay-Related Immunodeficiency Disease (GRID), due to its prevalence among gay men, are reported. It is later renamed Acquired Immune Deficiency Syndrome (AIDS).

1982: When hemophiliacs also begin to develop GRID, Dr. Bruce Evatt, a specialist in hemophilia at the Centers for Disease Control and Prevention (CDC), begins to suspect that the syndrome may be blood borne and presents his theories at a meeting of a group of the U.S. Public Health Service in July.

1983: Researchers at Dr. Luc Montagnier's lab at the Institut Pasteur, in France, isolate the virus that causes AIDS. They locate it in the swollen lymph node in the neck of a Parisian AIDS patient and label it lymphadenopathy-associated virus (LAV).

1984: Dr. Robert Gallo of the NIH announces that he has identified the virus that causes AIDS, which he calls (human T-cell lymphotropic virus (HTLV III).

1985: After dozens of Americans are infected with AIDS from blood transfusions, the first blood-screening test to detect the presence or absence of HIV antibodies--the ELISA test--is licensed by the U.S. government on March 2. The test is universally adopted by American blood banks and plasma centers. A legal battle over who deserves credit for the discovery of the AIDS virus finally ends in 1987 when the U.S. and French governments agree to share credit and royalties from the sales of test kits for the virus.

1987-2002: A series of more sensitive tests are developed and implemented to screen donated blood for infectious diseases: two tests that screen for indirect evidence of hepatitis; the Human T-Lymphotropic-Virus-I-antibody (anti-HTLV-l) test; the hepatitis C test; the HIV-1 and HIV-2 antibodies test; the HIV p24 antigen test; and Nucleic Acid Amplification Testing (NAT) that directly detects the genetic material of viruses like HCV and HIV.

Note: The material contained in this history was extracted from Red Gold; The Epic Story of Blood in the Blood History Timeline at http://www.pbs.org/wnet/redgold/history/index.html on February 15, 2010.

CONTINUING EDUCATION

THE GIVE AND TAKE OF BLOOD BANKING AND WALKING BLOOD BANKS

MLO and Northern Illinois University (NIU), DeKalb, IL, are co-sponsors in offering continuing education units (CEUs) for this issue's article on THE GIVE AND TAKE OF BLOOD BANKING and WALKING BLOOD BANKS. CEUs or contact hours are granted by the College of Health and Human Sciences at NIU, which has been approved as a provider of continuing education programs in the clinical laboratory sciences by the ASCLS PACE.[R] program (Provider No. 0001) and by the American Medical Technologists Institute for Education (Provider No. 121019; Registry No. 0061). Approval as a provider of continuing education programs has been granted by the state of Florida (Provider No. JP0000496), and for licensed clinical laboratory scientists and personnel in the state of California (Provider No. 351). Continuing education credits awarded for successful completion of this test are acceptable for the ASCP Board of Registry Continuing Competence Recognition Program. After reading the articles on pages 8-15, answer the following test questions and send your completed test form to NIU along with the nominal fee of $20. Readers who pass the test successfully (scoring 70% or higher) will receive a certificate for 1 contact hour of PACE.[R] credit. Participants should allow four to six weeks for receipt of certificates.

The fee for this continuing education test is $20. The MARCH 2010 CE Test covers all material in the Cover Story section except the Blood timeline. The Cover Story, Clinical Issues, and Lab Management published in this month's MLO are peer-reviewed.

Cover story objectives/CE questions written/approved by Gail S. Williams, PhD, MT(ASCP), SBB, CLS(NCA), Clinical Laboratory Sciences Program, College of Health and Human Sciences, Northern Illinois University, DeKalb, IL.

CE QUESTIONS

1. Out of its 309 million citizens, the United States had only__blood donors in 2006.

a. 9.5 million

b. 114 million

c. 15.5 million

2. In 1983, the FDA adopted a policy to reduce the risk of transmitting__via blood transfusion.

a. West Nile virus or WNV

b. syphilis

c. HIV/AIDS

d. HBV

e. None of the above.

3. During the late 1980s and 1990s, as many as 21,500 Americans were turned away from blood donation centers because of false-positive hepatitis C tests.

a. TRUE

b. FALSE

4. In 1999, the U.S. banned donations from people who had lived or travelled in Britain between 1980 and 1996 because of concerns that__could taint the blood and be transmitted through transfusion.

a. HIV/AIDS

b. Leishmania tropica

c. Phlebotomus papatasi

d. vCJD

5. The American Red Cross supports the FDA ban on blood donations from homosexual men.

a. TRUE

b. FALSE

6. The U.S. policy for persons diagnosed with__from Iraq is a lifetime donation ban because there is no guarantee of a 100% sterile cure of any version of the disease.

a. Leishmaniasis

b. Phlebotomus papatasi

c. variant Creutzfeldt-Jakob Disease

d. None of the above.

7. In some states in the U.S., blood donations have dropped in the past year largely because of

a. the threat of A/H1N1 influenza.

b. the lack of teen-aged donors.

c. the recession.

d. a national stockpile of blood products.

8. Technically, one donation of blood can be broken down into three components, any one of which could save someone's life: packed red blood cells, fresh frozen plasma, and platelets.

a. TRUE

b. FALSE

9. If you begin donating blood at age 17 every__days until you reached the age of 76, you would have donated__gallons of blood which potentially could help save more than__lives.

a. 45 days, 34 gallons; 500 lives

b. 56 days, 48 gallons, 1,000 lives

c. 90 days, 50 gallons; 750 lives

d. 180 days, 75 gallons; 1,000 lives

10. In the United States, approximately__% of the population is eligible to give blood, but only__% actually donate.

a. 37%, 5%

b. 50%,10%

c. 56%, 23%

d. 73%, 7%

e. None of the above.

11. After blood is drawn, it is tested for__and__.

a. HIV/AIDS, hepatitis B

b. antibody, cancer

c. malaria, vCJD

d. Leishmania Major, Trypanosoma cruzi

e. None of the above.

12. Whole blood donation takes about 45 to 60 minutes.

a. TRUE

b. FALSE

13. Statistics show that__% of us will require blood at least once in our lifetime.

a. 5%

b. 15%

c. 25%

d. 52%

14. Type__red blood cells can be transfused to patients of all blood types; only__% of people in the United States have this blood type.

a. AB-positive, 3%

b. O-negative, 7%

c. AB-negative, 10%

d. None of the above.

15. Blood donation is a safe, simple four-step process:

a. registration, medical history/mini-physical, donation, refreshments.

b. medical history/mini-physical, blood typing, donation, 30-minute rest period.

c. registration, medical history, donation, refreshments.

d. registration, family history/mini-physical, donation, blood typing.

16. A "walking blood bank" refers to donors (usually military personnel) for emergency blood collections who are co-located with the medical unit at the time of need.

a. TRUE

b. FALSE

17. Current Clinical Practice Guidelines in Iraq and Afghanistan clearly state that it is only appropriate to use fresh whole blood or FWB when

a. other blood products are unable to be delivered at a rate to sustain the resuscitation or an actively bleeding patient.

b. specific stored blood components are not available.

c. when stored components are not adequately resuscitating a patient with an immediate life-threatening injury.

d. All of the above.

e. None of the above.

18. All U.S. recipients of FWB in theater are required to be tested initially and at three, six, and 12 months after transfusion, according to current policy.

a. TRUE

b. FALSE

19. When the use of a "walking blood bank" is needed, ABO/Rh of the donor may be established via local testing or previous donor history. I.D. tags or "dog tags" for ABO/Rh verification should be used

a. to confirm the donor's blood group and type.

b. to confirm the donor does not have a transfusion-transmitted disease.

c. only as a last resort.

d. All of the above.

e. None of the above.

20. During combat, U.S. military doctrine allows the use of unscreened (by U.S. FDA standards), voluntarily donated, and freshly collected blood products to save patient lives.

a. TRUE

b. FALSE

MLO's Continuing Education Test is online also.

Both the CE test and a convenient payment feature are available through the auspices of Northern lllinois University.

Go to www.mlo-online.com/CE.aspx to print or to send electronically with payment.

[ILLUSTRATION OMITTED]

CONTINUING EDUCATION

To earn CEUs, see current test on pages 18-19 and at www.mlo-online.com under the CE Tests tab. The CE test covers all material in the Cover Story section except the Blood timeline.

LEARNING OBJECTIVES

Upon completion of this article, the reader will be able to:

1. Be aware of blood donation requirements and statistics.

2. Recognize infectious-disease risks of donated blood.

3. Identify most needed blood types.

4. Be familiar with different rules for military transfusions.

By Carren Bersch, Editor
COPYRIGHT 2010 Nelson Publishing
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2010 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:COVER STORY
Author:Bersch, Carren
Publication:Medical Laboratory Observer
Geographic Code:1USA
Date:Mar 1, 2010
Words:6640
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