Musing About Blood

October 4, 2006 at 4:58 pm (Sam's Posts)

Not too much to report here. I tried to give blood last week at the Hospital, and ended up waiting 45 minutes for a verdict on my eligibility. Denied. I have a genetic prothrombin mutation, and protein c deficiency. Both contribute to an increased likelihood of blood clotting. But neither has been explained to me as limiting in any other way other than a recommendation to stretch after long periods of inactivity. I had the head of the blood drive on the phone with the official Red Cross doctor in the vicinity for a half hour. Protein C is listed in the Red Cross database but is not an issue unless medication (e.g. coumadin) is being taken. The prothrombin thing is not in the database at all, even though 1-2% of the general population is heterozygous for the mutation. I got tested a few years ago for it only because my uncle had a blood clot and subsequently found out he had it. So there are probably a lot of people out there who have this mutation but don’t know it. I don’t think the condition is supposed to bar me from giving blood for life, so I am going to call my doctor. Either the authorities were wrong, or Red Cross should pay more attention to this condition. At least put it in the database.

Incidentally, I am reading Blood: An Epic History of Medicine and Commerce. I just finished a long section on blood and World War II. It was absolutely epic. Nothing like a war to encourage fast-paced advancement of medical technology. Predictably, there’s been a lot of talk about America, England, and France (as well as other developed countries) but not a lot about developing nations. I wonder what the blood donation systems of other countries are like, and in particular how countries interact with each other regarding blood. I think some of this is going to be clarified later in this book I’m reading though.

There’s not a shortage of blood within the U.S. anymore, is there? Is the surplus shipped out of the country? How much of a push is there to get blood/equipment to areas that don’t have access to these things, or haven’t prioritized them highly? I wonder. 

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3 Comments

  1. msoule said,

    Hey Sam
    Sorry to get back to this so late. My friend Dr Jim Perkins is the director of blood banking at Evanston Northwestern Hospital and I am forwarding him this link. He is doing work with blood banks in India and Pakistan and is very qualified to answer your questions for all of our edification. Blood is an incredibly important part of the healthcare provision question and Jim has loads of expertise.

  2. Jim Perkins said,

    Sam & Mike:

    In fact, blood shortages are pretty common in the states, particularly for group O red blood cells (RBCs) around the holicays and in the dog days of summer. For example, on September 11, 2001, there was less than 1/2 day’s supply of group O neg RBCs available in Chicago (New York was much better off). The shortage of “O’s” occurs because we overuse group O blood for a variety of purposes (emergencies, newborns, folks with antibodies) and because there is a disparity between the recipients (inner city, more group O and B Asian-Americans and African-Americans) and the donors (suburbs and smaller cities, more group A European-Americans.

    Shortages are, of course, more common in developing countries. Defining “shortage” is tricky however, since it is just part of a shortage of medical resources in general. If you look at the rates of blood use to population they are far lower than in this country as part of an overall, but larggely reflect far lower rates of medical intervention in general. In many countries in Afica and South Asia there is simply little infrastructure to support blood tranasfusion.

    A major issue in developing countries is the use of paid blood donors, who virtually always have higher rates of transfusion-transmittable diseases. For example, about half of India’s blood comes from “replacement” donors. Although the idea is that these are family members and friends recruited in advance of an individual’s surgery, in fact many are low income people paid to donate by the family.

    There is little traffic of blood components proper (RBCs, fresh frozen plasma, platelets) between countries, largely due to regulatory issues. in the past New York City used a lot of “Euro-blood” (from Belgium), but this has stopped because of mad-cow disease concerns. There is, however, a large international commerce in plasma derivatives such as anti-hemophiliac factor. Most of the source plasma for these products does come from paid donors, but these products can be sterilized to eliminate hepatitis viruses and HIV.

    “Blood; An Epic History…” is a pretty good book in general, although it completely misses the importance of individual state regulation in the switch to a volunteer blood supply in the states.

    Yours, Jim

  3. misarita said,

    This reminds me of several very sad stories that I’ve heard here in India about hemophelia patients developing HIV, hepatitis and a host of other diseases because of the replacement donor problem. One hemophelia patient told me how he used to give blood under a false name because he needed transfusions so frequently that he couldn’t get family members to donate enough. In Nigeria, many HIV patients were infected because they had to bring their own blood to the hospital if they needed a transfusion, so they would buy it on the black market.

    I’m convinced. I’ll go give my blood as soon as they’ll let me when I get back.

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