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NIH Record

New Procedure Doubles Usefulness of Blood Donation

By Rich McManus

Photos by Ernie Branson

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When you lie down to give your pint of blood at the Clinical Center Blood Bank, it's almost taboo to think that not all of what you're giving is essential. Fact is, however, that the department of transfusion medicine (DTM) needs mainly the packed red cells; the plasma is, in many cases, discarded or frozen for eventual reuse. To address this skewed economy, the Blood Bank now offers a "double red cell" procedure that allows a donor — in slightly more time than regular blood donation — to give twice the volume of packed red cells than in a normal donation, and get back his or her plasma and platelets, along with enough saline solution to restore the volume of red cells lost, usually in the range of 360-400 milliliters.

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The donor then rises from the recliner having parted with twice as precious a gift as regular donation, and commences typically to utter apropos one-liners: "I feel twice as good. I feel like I've accomplished twice as much." Or, "Does this mean I get a coupon for a return visit to the donor snackbar in a month? After all, I donated two units of red cells but I got only one set of cookies!"

The finished product of the 35-minute procedure — two happy, healthy units of packed red cells.

According to Dr. Susan Leitman, chief of the DTM blood services section, one wag rose up from the 35-minute procedure asking, "Can I get an 8-hour parking permit (for donor parking) instead of a 4-hour permit?"

Well, nobody promised the procedure would sharpen wit, but Dr. Charles Bolan, the first person to donate double red cells at DTM — and the source of the comments above — maintains that he felt a lot better later in the day than he would have following a regular donation. He adds, "I feel like my blood is less viscous today, so I'm more alert mentally."

That benefit alone might prompt many to sign on for the procedure, which is already win-win for both donor and recipient. "Everybody benefits," says Leitman. "Donors end up making one trip to NIH instead of two. The donor recruiters make one phone call instead of two. The donation itself is twice as useful. The $50 to $60 we spend doing viral safety testing on the blood sample is only done once. And we only have to do one blood group/type test. We get two units out of one donation, which we keep together in storage since most patients who need the cells get two units anyway.

"Patients benefit by being exposed to a lower number of donors," she continued. "It's a big advantage to the patient, the Blood Bank, and the donor."

DTM is currently targeting the blood groups it needs most (type O), and those donors for whom it's the biggest hassle to come to NIH regularly. The department recently combed its records for group O donors who visit three or fewer times a year, and mailed out some 700 invitations to participate in the new procedure (though all inquiries are welcome, insists Leitman). One of those who responded affirmatively was Hannibal Guerrero, who, on Oct. 28 became the fourth person to donate double red cells at NIH.

"I just do it because it makes me feel good," said the Bethesda resident, who was first drawn to blood donation at NIH a year ago by a recruitment sign posted on Old Georgetown Rd. Because he works in northern Virginia, it's not easy to visit the Blood Bank regularly. "I feel like it's my community service," he said with a broad smile.

Dr. Charles D. Bolan, a fellow assigned by the Army for 2 years to the department of transfusion medicine, becomes the first person to donate double red cells at NIH. The machine that allows the procedure — a Haemonetics MCS+ — is in the foreground. "It's fun to see the plasma and red cells in transit," said Bolan. "It's very interesting."

The NIH Blood Bank, whose goal is solely to service the needs of CC patients, currently uses some 5,000 units of packed red cells annually, and around 30,000 units of platelets. Because the long-dormant heart surgery program at the CC is gearing up to begin again, Leitman foresees a doubling of the need for red cell collection.

"Within several years, I would predict that at least 50 percent of blood donations here will use automated cell separation," she forecast. "It allows a blood center to tailor what it collects to the needs of the patients it serves. It also minimizes wasting and outdating because you are collecting most efficiently what you need. It really makes optimal use of your pool of willing donors."

Automated cell separation, or apheresis, is a procedure that uses the same size needle, and the same location (the antecubital vein in the arm's elbow joint) as traditional blood donation. But instead of the blood going into a collection bag, it travels in plastic tubing to a machine that spins the blood centrifugally in a bowl. As the blood components separate by weight in the spinning bowl, siphons remove needed components. In double red cell donation, only the packed red cells are kept; the plasma and platelets come back to the donor, along with some salt water. So instead of being down 500 ml of volume, as in a typical donation, the apheresis donor gets all volume back: saline solution in equal measure as red cells lost, plus all the plasma except a tiny spritz. "Red cells are happier with a little bit of plasma mixed in," notes Leitman. Donors need not fear exposure to another person's plasma; the donor remains connected to his/her blood throughout the entire procedure.

Dr. Susan Leitman, chief of the blood services section at the department of transfusion medicine, keeps a watchful eye on the dials of the apheresis machine during Bolan's donation.

"It's very, very safe to collect two units of packed red cells, while returning the rest to the donor," she assures, though there are some restrictions. Male donors must be at least 5'5" and weigh 150; women must be 5'1" and weigh 130. Also, the wait between double red cell donations is twice the wait between whole blood donations — 112 days vs. 56 days.

"Coming to NIH to donate blood every 4 months has got to be more convenient than coming every 2 months," notes Leitman.

Both whole blood and double red cell donors can expect to feel a bit of fatigue following donation, but Leitman says a large published study indicates no increase in adverse effects for the latter category.

"Because citrate is used in double red cell donation (as a preservative), donors may feel some tingling around their lips and fingers for about 15 minutes," she said. "Some donors report they can feel some effect in their stomach. But we can slow down the rate (at which citrate is added) if it becomes uncomfortable."

NIH is experiencing a constantly increasing need for red cells to support a burgeoning kidney transplant center in the CC, as well as programs in stem cell and pancreatic cell transplantation, Leitman explained.

"In particular for group O red cells, we're right on the border of meeting our needs," she said. "We have gotten dangerously low in our supply of red cells for some surgeries. The double red cell collection allows rapid replenishment of low inventory. It's great for building back up a depleted reserve."

The double collection is especially good in two other areas, said Leitman: donors with extremely rare blood types can provide far more good for more patients with a single donation; and those who want to store their own blood for elective surgery (autologous donation) get both the safety of their own blood for transfusion, and suffer only one needlestick for the two units that are typically stored for future use.

Leitman says the advantages of apheresis are so evident that NIH may move toward the procedure as a means to collect almost every blood product it needs: platelets and plasma as well as red cells. And not only do DTM staff enjoy using the new technology, but also patients get "lots of attention from our staff," she said. "We give them T-shirts and buttons, and they feel like superstars."

If you are interested in double red cell donation, contact the Blood Bank at 496-1048.


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