- The Washington Times - Sunday, September 2, 2001

Susan Baldassari had given blood before but never thought about who might benefit from the donation.

Then one Wednesday three years ago, she was on her way to return a movie at the neighborhood Blockbuster and her car was hit by a drunken driver. Severely injured, Mrs. Baldassari needed several immediate surgeries and more than a dozen units of blood.

"I can remember the doctors saying, 'We can't go in yet; we are waiting for blood,'" says Mrs. Baldassari, of Vienna. "They were just waiting for it to come from upstairs, but I was thinking to myself, 'What if they don't have the blood?'"

Since the accident, Mrs. Baldassari has had 13 surgeries. She still donates blood as often as she is allowed in the hopes that there always will be a plentiful supply of blood for trauma and surgical patients like herself.

A nationwide blood shortage is a real concern not only for patients, but for doctors and officials who run the blood banks. An aging population, medical and surgical advances that require more blood, and new restrictions deferring donors in an effort to keep the human form of mad cow disease out of the United States have worsened the situation.

"We have got to do a better job of getting ahead of the supply so we do not get in a situation where we have to make tradeoffs with people's health," says Dr. Bernadine Healy, president of the American Red Cross, which is responsible for almost half of the nation's blood collection. The rest is collected by hospital-based collection centers (10 percent) and community blood banks (45 percent).

To donate blood, a person must be in good health and older than 17 and must weigh at least 110 pounds. Once at a blood bank, a potential donor also must answer health history questions and take a hema-tocrit (red blood cells) test.

About 60 percent of the United States' population is eligible to donate, but just about 5 percent do so, according to the Red Cross. The pool of current donors is expected to shrink by 8 percent about 400,000 people as new Red Cross guidelines go into effect next month.

Under the new guidelines, anyone who has lived in the United Kingdom for a total of three months since 1980, anyone who has lived in Europe for a cumulative total of six months since 1980 or anyone who has received a blood transfusion in the United Kingdom since 1980 will be restricted from donating blood.

Since 1999, the Food and Drug Administration has been advising all blood centers, including the Red Cross, to defer anyone who has been in the United Kingdom for six months or who lived in France for 10 or more years.

The FDA announced its new restrictions on Monday and gave blood banks until May 31 to prepare for the cuts, the Associated Press reported.

In the new, tighter FDA plan, blood banks would bar blood and plasma donors who have spent three or more cumulative months in Britain from 1980 through 1996, have spent five or more cumulative years in France from 1980 to the present, or who received a blood transfusion in Britain since 1980. U.S. military personnel or dependents who were stationed at Northern European bases for six months or more from 1980 though 1990, and elsewhere in Europe from 1980 through 1996, would be barred from donating blood.

"We know mad cow disease exists, but there are a lot of unknowns about how it is transmitted," says Dr. Jeanne Luma-due, medical director of Inova Blood Donor Services. Before Monday's announcement, she had said she expected "the FDA will shorten the length of time permissible to three months."

The FDA says the U.S. blood supply has never experienced a one-time donor loss of more than 3 percent. This will impact some areas of the country more than others. The New York Blood Center in Manhattan, which has a high concentration of immigrants, people who travel to Europe frequently, and a large number of blood units (or pints) imported from Europe, expects a unit drop of 35 percent under the new guidelines. Meanwhile, nearly 5 million U.S. military personnel who were exposed to British beef supplies will be ineligible and strain the supply further.

"I do not believe there is a strong indicator that mad cow disease is transmitted by transfusion," says Dr. Celso Bianco, executive vice president of America's Blood Centers, the industry group that oversees the community blood banks. "But just to be safe, we have to use the precautionary principle. We have to go with what the FDA says and do something to minimize risk until you have sufficient information. However, the shortage of blood is much more serious for patients than the risk of getting mad cow disease."

How it got this way

An adequate supply of blood existed years ago. The World War II generation began donating out of patriotism and continued doing so regularly. Employers would en-courage donations by sometimes giving employees a half-day off after donating.

Then the World War II generation began aging and dying. Employers wanted more productivity. Younger people used to earning a free T-shirt when signing up for a credit card wanted to know what they would get in return for the platelets.

"There definitely is not the same level of enthusiasm," Dr. Lumadue says. "We would love to be able to reward people more, but we can't give away too much. That would look like an ulterior motive on blood."

Actually, blood donations have increased in small increments in the past few years. The Red Cross collected 6.4 million units of blood from July 2000 to this past July, a 1.3 percent growth from the previous fiscal year. Increases of 5 percent, 3 percent and 2 percent have been recorded for previous years.

But more blood than ever is being used in procedures such as bone-marrow transplants, organ transplants, advanced cancer treatments and an increase in heroic measures used to save trauma patients and premature babies, Dr. Lumadue says.

A car-accident victim, for instance, can go through four to 40 units of blood, the Red Cross estimates. An adult undergoing open heart surgery needs at least two units of red blood cells, two to four units of plasma and one to four units of platelets.

Combine a situation such as a snowstorm (which often reduces donations greatly as people and Bloodmobiles cannot get out) with a highway pileup, and a community could be in a crisis.

"We always see stories about medical miracles, but they come at a cost blood," Dr. Lumadue says.

How to stop the shortage

The Red Cross, hospitals, blood banks and government agencies all are searching for ways to bring in more donors.

In May, the Red Cross began running a series of radio, print and TV ads urging people to give blood. The Red Cross spent $2.5 million on the campaign the first time in its 120-year history the organization has had to pay for advertising.

The Red Cross also has contacted 2 million donors who are Type O the universal blood type to get them to donate again.

"Perhaps the pressure is on us to rethink the way business is being done," Dr. Healy says. "The average existing donor donates 1.3 times a year. If we can get them to give 1.9 times a year, that could bring in 1 million units of blood."

As of midsummer, the Red Cross was seeing an impact from its efforts, she says.

"If we look at our numbers compared with last July, we have a much higher inventory of O red cells," Dr. Healy says.

The Red Cross also has put in place new technology aimed at saving blood for times when a seasonal shortage is expected. That includes collecting two units of blood at a time from some people, usually men with a hematocrit number higher than 44. Red blood cells can be kept fresh for just 42 days, and platelets last just for five, but the Red Cross is working on freezing some blood types during times when there is a surplus, Dr. Healy says.

The U.S. Department of Health and Human Services recently announced a nationwide sentinel system that will monitor the blood supply. Under the new program, 29 hospitals in 16 cities, including the District, will report their blood supply and demand levels to HHS to give a more accurate picture of availability in the region. The public eventually will be able to track the blood-supply levels in a particular area by checking a Web site.

Early next year, a survey sponsored by the National Institutes of Health will be distributed to 36,000 donors to try to find their motivation for donating blood and why most donors do not return.

"Only about 50 percent of first-time donors come back," says George Schreiber, the researcher heading the study.

NIH also is supporting a program aimed at increasing the iron supply of women of childbearing age. That would make more women eligible to be return donors, says Dr. George Nemo, head of the transfusion medicine scientific research group at the National Heart, Lung and Blood Institute.

It is going to take a sustained effort to make sure donors come back while other ones even those who spent an innocuous semester abroad are turned away.

"There is no danger of completely running out of blood," Dr. Lumadue says. "Some donors are always going to be there. However, more restrictions will put a crunch on all of us until we find our equilibrium."

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