You don't have to be a healthcare professional to be a part of providing lifesaving care, according to a medical technologist, prior to the start of Medical Laboratory Professionals Week (MPLW). Your part in the process is as simple as donating blood.
Doctors Hospital Medical Technologist Raymond Baillou says if you are willing and able to donate blood, you should do so; and if you are willing to donate blood, but unable to donate, you can assist medical professionals by helping them to educate others on the importance of blood donations.
"Everyone can play a role in the ultimate goal of saving a life," said Baillou at the recent Doctors Hospital Distinguished Lecture Series, just ahead of MPLW, which takes place April 19-25 worldwide. "You don't necessarily have to be a medical technologist or a physician, but you could also save a life by giving the gift of life by donating blood."
If you've ever had a loved one hospitalized for any reason, the medical technologist said, he or she probably needed a blood transfusion for lifesaving care or treatment. He said that far too often, the lives of friends, family members, neighbors, co-workers and fellow Bahamians hang in the balance because there's not enough blood in the blood banks; there is always an urgent need for blood donations to the local banks.
"It is important to donate [blood]," said Baillou, who added that during MPLW, medical laboratory professionals would be afforded the opportunity to increase the public's understanding of and appreciation for clinical laboratory professionals and the work that they do.
Importance of blood donation
For one single donation, three lives can potentially be saved, according to the Doctors Hospital medical technologist. He also said it is important to donate blood in The Bahamas because there is no national blood center where blood is readily collected and stored for use by hospitals.
"Contrary to the United States, to which Bahamian health care is generally compared to by the general public, blood is supplied to hospital and healthcare systems by a third party -- a blood collection center that collects, stores, processes and then sells the blood to the hospitals.
"In The Bahamas, there is no such blood collection center. We currently have only had blood banks -- Doctors Hospital Blood Bank, and the blood banks at the Princess Margaret Hospital in Nassau and the Rand Memorial Hospital in Freeport. All three of these blood banks are solely dependent on voluntary blood donors -- donors who are giving of themselves to help others, expecting nothing in return. With this model in The Bahamas, if there are no blood donors, there are no blood products, and subsequently no blood products available to a patient who may need it for lifesaving care. This is truly significant, because one out of every 10 hospitalized patients requires a blood product transfusion," said Baillou.
Who should donate
Anyone who is willing and able to donate blood should, according to Baillou. As blood donation is a voluntary act, he would like for people to try to donate with a willing heart, without feeling pressured to do so under the circumstances of a loved one in dire need of blood.
"We would like to move away from directing individuals to donate, but it seems as if these are the only times a person would donate, or if a loved one is in desperate need of blood."
For those persons who are willing to donate, the entire blood donation process takes approximately 30 minutes, according to Baillou. During the time, the blood bank personnel determine if a person is able to donate. At Doctors Hospital, there is an established step-by-step process that is followed before, during and after a blood donation.
Before a person donates blood, a donor must meet an established criteria. The medical technologist said each blood bank has its own protocols. At Doctors Hospital, they follow the guidelines set forth by the American Association of Blood Banks. Donors must be in general good health with no cold, flu or fever; he or she must be at least 18 years old and weigh at least 110 pounds. Donors must have eaten a substantial meal within 30 minutes to four hours of donating blood.
Screening
Once a donor has met the criteria, he or she is then screened. The donor screening encompasses a questionnaire and release card that the donor fills out and signs. It provides information about the donor's travel history, health history and lifestyle choices. If an individual has had a tattoo or body piercing within the last year, he or she cannot donate. For individuals who may be on certain medications, they may or may not be able to donate, based on the prescribed medication. Individuals taking high blood pressure medication can donate. Along with the questionnaire, the donor screening also includes a check of the donor's blood pressure and pulse, body temperature, blood iron level and determination of the donor's blood type.
If it's determined a person is unable to donate, based on their initial donor screening, Baillou said it does not mean that they are unable to donate ever, or that they can't donate in the future. He said it simply means that they cannot donate at that time. This often happens with women, regarding their blood iron levels, which fluctuate due to the menstrual cycle. At the initial donation, the blood iron may be too low for a safe blood donation, but may be fine at another time.
The medical technologist said the established criteria for blood donations, the donor questionnaire and the outlying checks assist the blood bank in not only ensuring the quality of blood donated, but also assist in ensuring the safety of each potential donor.
Once the screening has been completed, the blood is collected. The actual blood donation process takes approximately 10 minutes at maximum. According to Baillou, a healthy male usually has approximately 12 pints of blood and a healthy female has approximately 10 pints of blood. He said that at Doctors Hospital, the maximum volume of blood taken per donation is 450 milliliters -- the equivalent of one pint of blood. This amount of blood can be replenished within 24 hours, once the donor remains hydrated. After the blood donation is finished, the donor is offered refreshment in the form of juice, malt tonic or water in order to begin the rehydration process.
How often can you donate?
"A blood donor has the ability to theoretically donate every eight weeks or every two months, translated into six times a year. My personal opinion, donating every three to six months is exceptional -- and equates to two to four times a year -- which I do myself," said the technologist.
Once the donor has safely and successfully donated, the blood is screened. At Doctors Hospital, the blood screening involves blood bank and zurology testing. The donor's blood is retested, confirming blood type, as well as testing for any clinically significant antibodies and any clinically important viruses such as HIV, Hepatitis B, Hepatitis C and VDRL, the virus that causes syphilis.
When all laboratory testing has completed and it's been determined that the donor's blood donation is suitable for use in blood transfusions, the donated blood is processed and made into blood products. At Doctors Hospital, from the donation of one pint of blood, up to three blood products can be made. The blood products generated are packed red blood cells, fresh frozen plasma and platelets.
"From one donation, a minimum of one patient up to a maximum of three patients can be helped, because three blood products can be made. Potentially, the packed red blood cells can go to one patient, the fresh frozen plasma to another patient and the plasma theoretically to another patient," said Baillou. "Each blood product serves specific purposes."
But just like most things in the world, the blood products also have an expiration date, which is the primary reason why a readily available blood supply is a constant challenge, according to the technologist.
"At Doctors Hospital, the most utilized blood product is packed red blood cells, which expire in 35 days. It is made of red blood cells that contain hemoglobin and iron containing protein that carries oxygen throughout our bodies. This blood product is refrigerated. Fresh frozen plasma is made up of plasma, or the fluid or liquid portion of blood, composed of mostly water, proteins, minerals, fats, hormones and vitamins. It is where clotting factors are found. It also maintains blood pressure and total blood volume to satisfactory limits.
"It is stored frozen and expires in one year if not used. Platelets happen to have the shortest shelf life of them all. Platelets have a minimum shelf life of three days and a maximum shelf life of five days. Platelets are small, colorless cell fragments in the blood whose main function is to interact with clotting proteins to stop or prevent bleeding. They are stored at room temperature with constant agitation in order to maintain their functionality," said the technologist, whose role is to provide quality care to all patients in the form of testing, results, and in the case of the blood bank and transfusion medicine, safe and available blood products.
Who needs a blood product?
Baillou said a variety of patients require a blood product transfusion, and sometimes it may be a one-time thing, in the case of an accident victim or an ongoing treatment in the lives of a cancer patient or an individual with sickle cell anemia. Hospitalized patients who require a singular or multiple blood transfusions would be those people that need surgery or treatment for cancer, treatment for chronic anemia, trauma to the body in which there is a substantial amount of blood loss and it needs to be replaced; shock and burn patients, and for patients with bleeding disorders and coagulation disorders; and people undergoing an organ transplant procedure.
"At any given visit or admission into a hospital, one patient may use up to 50 blood products. Depending on the reason for the care needed, a patient can theoretically use 50 blood products from 50 different donors, during one hospital stay," he said.
Supply and demand
Baillou said blood donation all comes back to one of the most fundamental concepts -- supply and demand, and that the blood bank has to have a readily available supply of blood for the demand of transfusions in order to provide patients lifesaving care and treatment, if needed.
He said that at Doctors Hospital their goal is to collect 1,300 blood donations a year in order to meet the demand of blood transfusions. And that the total number of blood collected has been consistent over the last five years, with an increase in donations via blood drive as they emphasize reaching out to the community. But he said they have still yet to reach their 1,300 donations a year goal, because even though a donor has been screened, and a unit of blood is collected, that does not guarantee that that unit is suitable for use, as after laboratory testing has been performed, he said some units are determined to be unsuitable for use and are removed from general inventory which decreases the supply of available blood for use.
Baillou further said that at Doctors Hospital they pride themselves on optimizing their supplies, assuring that the blood donation is not wasted. But he said that was not always the case, as they had to work to decrease the numbers of their expired blood donations.
Expiration
In 2010 he said they found 108 units expired; in 2011, he said 116 units expired; in 2012, he said at Doctors Hospital they acknowledged the trend and revised their policies to limit the amount of units being wasted due to expiration and that they say less units expiring in subsequent years -- 63 units in 2012; 59 units in 2013 and 45 units in 2014.
"In blood banks, as it relates to blood products, the established expiration rate is one percent, which has been deemed to be acceptable. This equates to one out of every 100 units may expire, again decreasing the amount of supply available for use. When we take into account the units that have been determined unsuitable after testing, and for units that may expire, our magic number to supply an effective blood supply at Doctors Hospital Blood Bank is 1,105 units a year. Even though in the previous five years we have fallen short of attaining our calculated blood supply, we have been able to meet the demands of transfusions within the hospital -- sometimes, just barely."
He said that in 2013 at Doctors Hospital they transfused more blood than was actually collected, and he credited their colleagues at Princess Margaret Hospital Blood Bank with assisting them with blood donations for their patients. In other critical times, he said blood products had to be shipped in from the United States for patients.
"Simply put -- supply versus demand, blood donations versus blood transfusions. If you are scheduled for elective or scheduled surgery, or a family member requires regular transfusions as part of their treatment, do not assume a supply is available, please send donors in advance of your admittance into the hospital in order to ensure that blood is readily available for your use. The demand for blood may be greater than the supply of it," said Baillou.
Cost and demand
While blood donation is a voluntary process and the blood donated is free, there is a cost associated with a blood product or blood transfusion in the hospital. Baillou said the cost is not actually for the blood, but for the different laboratory tests performed to ensure that the blood is safe and for the processing of the blood to make it into blood products, and the proper storage of each blood product, assuring that it is of high quality for a transfusion.
In an effort to meet the demands for blood donation, Doctors Hospital has taken a proactive approach to collecting blood through their corporate blood drive program, educating the public about the importance of blood donations, debunking myths about donation and alleviating any anxiety about the processes from blood donation through to blood transfusion.
As medical laboratory professionals use this week to increase the public's understanding of and appreciation for clinical laboratory personnel and the work that they do, they are also looking forward to observing World Blood Donors Day observed on June 14, a day set aside to thank donors worldwide for helping and saving lives. The day also serves to raise awareness of the problem in maintaining a safe and readily available blood supply, especially in developing countries such as The Bahamas.
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