Cancer Answers: Donating Blood to Help Cancer Patients, August 17, 2008

Dr. Edward Snyder and Paul Sullivan, Donating Blood
to Help Cancer Patients
 August 17, 2008Welcome to Yale Cancer Center Answers with Dr. Ed Chu and Dr.
Ken Miller.  I am Bruce Barber.  Dr. Chu is Deputy
Director and Chief of Medical Oncology at Yale Cancer Center and
Dr. Miller is a medical oncologist specializing in pain and
palliative care and he also serves as the Director of the
Connecticut Challenge Survivorship Clinic.  If you would like
to join the discussion, you can contact the doctors directly. 
The address is 
canceranswers@yale.edu and the phone number is
1-888-234-4YCC.  This evening, Ken Miller is joined by Paul
Sullivan, CEO of the Connecticut Chapter of the Red Cross, and Dr.
Edward Snyder, Director of the Yale Blood Bank and Transfusion
Service.Miller
 I want to start out with a fairly basic question. Why should
people give blood?Sullivan
 We need people to give blood because, candidly, it saves or
sustains lives.  There are patients across the country who
count on volunteer blood donors, people like you and I, to come out
and do what is a fundamentally altruistic act and support other
people. It is really almost a "pay it forward" so that people today
can be saved by the excellent hospitals and physicians we have in
Connecticut.  It really is a basic and vital part of our
healthcare system.Miller
 How many blood transfusions are given in Connecticut every
year?Snyder
Every year in Connecticut we send out about 165,000 red cells,
another 25,000 of what we call platelet dosages, and then probably
another 50,000 plasma units.  Over the course of the year,
through our donors' good acts, we are helping well over 300,000
people.Miller
 This is a huge number, far more than that I might have guessed,
personally.Snyder
Quite frankly, I think a lot of people do not appreciate what an
important and substantial operation blood banking is. I say that
from the standpoint that in order to collect those units and to get
them out to patients across the state, obviously there need to be a
lot of dedicated volunteers and staff as well as donors. There is a
pretty significant operation, again partnering with the hospitals,
to make sure that the blood is ready when it is needed because the
other thing about our business that is challenging is that it is
unpredictable by nature.Miller
 Yeah.Sullivan
 From Yale-New Haven Hospital we use approximately 70,000 blood
products a year.  We transfuse somewhere between 7000 and 7500
people a year.  We require about 70 to 80 units of red cells a
day, 40 doses of2:30into mp3 file 
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 platelets a day, and somewhere around 30 or 40 units of plasma a
day. This is every day because obviously the sick do not take a
holiday.  During weekends, holidays and summertime, people are
having surgery, there are accidents, larger amounts of blood are
needed and we rely very heavily on the Red Cross and the altruism
of people in the State of Connecticut to donate blood to keep those
supplies coming to save patients.Miller
 I will share a personal story.  My wife had acute leukemia
about 9 years ago and thankfully she is well, but I think about all
those donors whom we will never meet who gave blood products; some
of whom donated multiple times, platelets, and what a wonderful
thing it is to give blood.Sullivan
 We constantly try to figure out ways to share information back and
forth between patients and donors, while obviously protecting
privacy, but you know the reason we want to share it is because the
stories are incredible. The way it hits home to people is obviously
very profound when they think about the fact that someone took a
couple of hours out of their day, and that really makes a
difference in someone who is getting the care they need. What I am
always trying to convey is just as Dr. Snyder said, we need it 7
days a week and some of our products literally have a 5-day shelf
life; our platelets have a 5-day shelf life. It is not something
that we can let ourselves as a community, and as individuals say,
"I am going to do that next week, or next month." It is the
summertime and understandably people want to be with their family
and want to do other things, and God bless them, obviously they
should be doing that, but we need them to squeeze in a little bit
of time to do this, because places like Yale and other hospitals
all across the state are giving great care to people and people do
not know when they are going to need it.Snyder
After the horrible events of 9/11 occurred, hundreds and thousands
of people donated blood in an attempt to do something for the
victims, and it turned out that if 100,000 people donated blood on
a given day, 5 days later all of those platelets would have to be
thrown out if they were not transfused, because the shelf life is 5
days.  So rather than people coming in motivated by a tragic
and horrific event, it would be better for someone to come in 2 or
3 times, or at least once or twice a year, and spread out the
donation so that we have enough blood all the time.Miller
 What are the things that concern people who are thinking about
being a donor? What are some of the things that they tell
you? Sullivan
 It is a range of issues, and all of them are very
understandable.  Blood donation is simple.  It is easy,
and it is important, and it should not be5:23into mp3 file 
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 taken lightly. If people get nervous about needles, the good news
is that
 we take the unit of blood from essentially your inner elbow, which
is an area where it has very few veins so while it may be a little
bit intimidating,  it is merely a pinprick in terms of what
you feel.  People obviously are concerned about the mini
physical we do and that is one of those interesting things. Those
mini physicals, aside from making sure the blood is safe for a
patient, are a great public help for the State of Connecticut and
for the country. It is important to regularly know your blood
pressure, your pulse, your temperature, and your hemoglobin and
hematocrit, because those are indicators of wellness.  People
get nervous about going through a mini physical, just like they get
nervous going to the doctor, but just like going to the doctor,
there is a benefit, aside from just making sure that you know the
blood is going to be available for a patient.Snyder
There is the aspect too that people now realize that the world is a
much smaller place, everyone is in essence responsible for their
fellow human and donating blood is something that will be nice to
do if you have nothing else to do.  It is almost a
responsibility.  It takes a village really is true, and yes,
putting a needle in your arm may be a little uncomfortable, but
compared to some other things that people feel the need to do,
donating blood is something that is such an altruistic act and you
never know when you are going to need blood as well. A lot of
people sign up for blood drives for someone that they know, because
it personalizes it. They say, "I knew this young man who developed
leukemia and I wanted to donate for him", but there are lots and
lots of people everyday that come through the portals at Yale who
do not have people to set blood drives for them and they rely on us
having blood for them. That is why the simple act of donating blood
is critical, and as Paul mentioned, the blood is divided. 
There are basically 4 parts of the blood.  There are the red
blood cells, which carry oxygen, there are the platelets which are
little tiny fragments of cells that are important in blood
clotting, and there is plasma, which is the part of the blood that
contains various chemicals and proteins that you need for good
blood clotting and other types of functions.  There are also
white cells, which are not so much needed for a regular
transfusion, but are useful for people who may need white cells for
other reasons related to transplants and so forth.Miller
 If someone says, "I do not want to give blood because I could get
hepatitis from giving blood or I could get HIV," is that truth or
myth?Snyder
That was a problem during the AIDS scare years ago and I think to
some degree it is going to be with us for the rest of our
professional careers.  People thought that you could get AIDS
by donating blood or hepatitis by donating blood, and that is an
absolute myth.  Every blood bag is8:30into mp3 file 
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 completely sterile.  It is one use and is thrown out if it is
not successful.  We do not reuse bags, we do not reuse
needles. People are much more sophisticated today, and personally,
I think it is not the fear of getting AIDS or hepatitis from
donating blood, I think it is the fear of needles that keeps most
people away. You can come up with a million excuses.  If it
was something like having dinner or eating ice cream, you would
find the time. The idea that the needle is something to get
through, personally, I think is there is something people need to
realize, it is relatively minimal.  It is a little more than
just a mosquito bite or a pinprick, but it is certainly a lot less
difficult than going to the dentist. Some people do not like to go
to the dentist, but you need to do what you need to do.Sullivan
 We need to demystify the blood drive for those who have not
given.  There are a number of folks who come regularly. They
know how to do it, and it is awfully easy. They also know at the
end of it they will feel great.They will feel great because of the psychic reward of knowing
that they have contributed to their community; they will have
likely either sustained or saved the lives of 1, 2, maybe 3 people.
The part that people just need to get over is that it is a
straightforward easy process and the Red Cross is waiting to take
you, we are eager to have you come and we want to make it a
friendly positive environment. In the end the most important thing
is when you have that moment of self-actualization where you know
you have made a difference. In the case of your wife, or other
folks who receive blood, they do not know who that person was, but
a few days later or a couple of weeks later depending on the
product, there are people sitting there, or their family is sitting
there saying, thank you so much, and that is a pretty powerful
thought. Snyder
On the radio and television you see advertisements of various
hospitals talking about bloodless surgery, and most of the
surgeries that are done at Yale are bloodless, but there are some
surgeries where blood is required. Those are often at the major
hospitals, so called tertiary care hospitals, where people can be
flown in by helicopter or brought in by ambulance where they have
either had a major accident or some problem where blood is
required. We use the least amount of blood possible and the
indications for transfusion of all types of products, plasma,
platelets or red cells are always being redefined.  There
still is a great need despite our desire to use the least blood
possible as more and more people are having more and more
complicated surgeries. Thanks to major advances in medical care
people who could not be saved years ago are now being saved
routinely because of major advances in trauma surgery and
resuscitation and the ability to handle people at an accident site
and bring them into the hospital where they can be saved. To see
those families reunited and know that11:36into mp3 file 
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 blood transfusion played a role in the salvage of that family
member, the father, child, mother, the sister, brother or daughter,
is an excellent feeling. There is no other feeling like helping
someone else when you donate blood.Miller
 I am going to refer to the care as TLC (tender loving care). 
What is the process, after the donor comes and puts his or her arm
out and the unit is drawn, what happens then?Sullivan
 Essentially, when you come to a blood drive there are a couple of
different stages that I mentioned earlier in terms going through a
physical and making sure that it is safe for you to give and safe
for the person to receive it.  There is the phlebotomy, which
takes 10 to 15 minutes, and is the drawing of the unit. Then we do
ask people to stay for TLC time, if you want to call it that, and
it's just sitting and we give them juice to make sure they are
feeling hydrated and well. There are many instances where people
can just sit and talk to neighbors or other community
members.  It is kind of fun at a blood drive.  When
people are done they usually feel very strongly that they need to
hurry through the process to give blood, and we understand that we
are all rushed and we are hurried and time is precious, but it is
interesting.  We will see people sit for quite a while in our
canteen talking about what they have just done or getting to know
their neighbor because it is almost by definition only good people
that congregate in a blood drive. Once you are there you have
joined the ranks of people who are interesting and caring.  We
do ask people to stay for another 15 minutes, and some stay longer,
at the end of a blood drive.Miller
 After the donor has gone home, that unit of blood then travels
somewhere.  What is the process for that unit of
blood? Snyder
The unit of blood is processed at the blood center and as was
mentioned, it is divided into different components; the red blood
cells and the platelets, the red blood cells for carrying oxygen,
the platelets for helping with blood clotting, and plasma, which
also helps with blood clotting. Each one has different storage
requirements.  The red blood cells need to be stored in a
refrigerator at a specific temperature of 1 to 6 degrees
centigrade.  Platelets need to be stored at room temperature
on a little shaker at 20 to 24 degrees, and plasma needs to be
frozen at -30 degrees.  You just cannot take 1 unit of blood
and expect to put it on the shelf and have it serve all the
purposes, because we are much more sophisticated knowing what each
component is needed for.  If a person has a low platelet count
because they have cancer and they have been given chemotherapy and
the platelets, which help blood clot, have dropped, but the red
blood count is normal, they do not need a unit of whole blood just
to get the platelets.  You would14:24into mp3 file 
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 rather take the platelets out of that unit of whole blood. 
Then you have the red cells left over and the plasma that can go to
other people that may need those specific components and that
concept is called component therapy.  So that is done at the
blood center and then we make a request to the Red Cross each day
of how much blood we need to put on the shelf at Yale-New Haven
Hospital and that is provided by the Red Cross by courier.Miller
 Terrific, we would like to remind you to e-mail your questions to
canceranswers@yale.edu. 
We are going to take a short break for a medical minute. Please
stay tuned to learn more about blood donation with Paul Sullivan
and Dr. Edward Snyder.Miller
             
 Welcome back to Yale Cancer Center Answers.  This is Dr. Ken
Miller and I am here with Paul Sullivan from the Connecticut
Chapter of the American Red Cross and Dr. Edward Snyder from the
Yale Cancer Center. I want to talk about a related, but different
topic. For people that need a blood transfusion, one of the things
they think to themselves is, is it safe and what is going to
happen?  Is the blood supply safe and how do you make sure of
that?Sullivan
 We work very hard to ensure that it is safe, and it is actually
very safe.  As Dr. Snyder mentioned, we bring the blood back
from the blood drives all across the State of Connecticut up to
Farmington.  We then take those test tubes and we send them to
Philadelphia.  We have people running those down twice a day,
every day, and then we get those tested for a number of viruses and
other markers that might indicate that the blood is not safe for
transfusion.  As we learn more about potential risks, we
identify them and16:55into mp3 file 
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 work hard to identify tests to protect against them.  We have
recently added West Nile testing, Chagres testing, and we obviously
have HIV and HCV.  As Dr. Snyder said, it is never a trivial
event to be transfused.  We have done everything that we can
to make sure that blood product is safe. When someone needs it,
they need it, and now there is a very little, almost infinitely
small risk of getting transfused with a known virus. 
Obviously people take it very seriously to be transfused and so
they only get it when they absolutely need it because there are
other risks; someone who is receiving the transfusion, whether it
be bacteria in the blood or other issues that we can't identify,
obviously, that is avoided when possible. There are two sides of
it, one is the issue of blood safety and the other is the fact that
we are often short of blood products and it is used only sparingly,
but yet we still see demand grow, which again to me reinforces just
how vital that product is to the patient who receives it.Snyder
And we see the concept that someone else will donate so they do not
need to. The blood that is needed is needed constantly and the
blood is tested for 8 or 9 different things to ensure that it is as
safe as possible. We are still making research efforts to try to
come up with a blood that could be grown in a laboratory. 
People are probably saying that with all the medical marvels, and
we can put a satellite on Mars, why can't we come up with blood
that they make in a factory?  We are trying to do that, but
the biology of it is quite complex and the more sophisticated we
become, the more we realize how much more we have to do.  It
still comes down to a person who is concerned and cares about their
fellow man woman and child to come into a blood drive and roll up
their sleeve and donate the gift of life. As hackneyed as that may
sound, it comes down to that and anyone who has needed a unit of
blood expects that it will be there, but the only way it happens is
if one person decides to take responsibility for another. 
With all the science and all the technologies not withstanding, we
still need people to donate for other people.Sullivan
 Yes, it is true.  The other thing I am just going to mention
in terms of blood safety is that there are the tests that we have,
which are exceptional in their sophistication and accuracy, but we
also rely on the questions I mentioned earlier and some of those
are personal, but they are important. The reason we ask people
where they have traveled and so on, is because we are looking for
correlations to diseases.  We can test for malaria for
example.  There is a very low incidence rate for the average
traveler even to a place endemic for malaria, but we still ask the
question and we still ask people not to donate when they have been
in those areas simply because if we do not have a good test for
something, we want to try to avoid there being any chance that it
gets in the blood supply.19:58into mp3 file 
http://www.yalecancercenter.org/podcasts/Answers_Aug-17-08.mp3Miller 
 A question for you about aphaeresis, which is a term that we
use.  What does that mean and what would that donation be
like?Snyder
Aphaeresis is a Greek term, meaning to remove.  Basically, the
concept is instead of taking 1 unit of blood from a person with a
needle in the arm and a blood bag, you have a person go on a
machine, which is somewhat like a cream separator, although I will
admit I say this all the time and I have never seen a cream
separator, but I am sure it must look like this.  It is
basically a centrifuge.  It is a device that spins.  So
blood comes into the machine and the machine spins the blood into
red cells, platelets and plasma the way the Red Cross would process
this as a single unit of blood, but the machine is able to remove
only the part of the blood that is specifically needed.  So if
someone is donating platelets, they donate whole blood in one
arm.  The machine processes the blood while the patient is
sitting there. It the returns to the patient, a normal volunteer
donor not a patient, the plasma and the red cells that are not
needed.  If someone is donating red blood cells, then the
machine would keep the red blood cells and donate back to the
normal volunteer the platelets and the plasma and the various
permutations and combinations. A unit of red cells and a unit of
platelets can be taken as well, because quite frankly, since about
3% or 4% of the population donate blood for everybody, we are
always in need of blood.  If you can safely, and that has been
a very big issue, donate 2 units of red blood cells at one time, or
a unit of red cells and platelets, the machines can do that. 
They are monitored.  They are all licensed by the FDA and we
do research on that at Yale as well.  This is a way of
extending the ability of one person to donate more than just one
unit of blood, which has been quite helpful.  There is a
certain part of blood banking where you have to have inventory
management and that is where we work closely with the Red Cross to
make sure that every unit of blood that is given by a person is
used in the best possible way to help save lives.Sullivan
 It is one of the things that we have been very focused on at the
Red Cross for the last few years. We do have very concerned
hospital partners in terms of how we store those products, and it
is remarkable quite frankly, if you think about the fact that we
have random presentations of donors pretty much every day.  We
do not know exactly who is coming, what their blood type is, etc.,
and we have random presentations of patients. We work very hard
literally day and night.  We have team members driving blood
back and forth, bringing it to hospitals, calling the hospitals,
asking what they have on their shelves, what they do not have, what
they need, what they can share with other hospitals. We are
constantly, both on a local and national basis, reallocating those
blood products to make sure that we have it where it is needed,
when it is needed. I sometimes get the22:56into mp3 file 
http://www.yalecancercenter.org/podcasts/Answers_Aug-17-08.mp3question; will my blood stay in Connecticut?  Well the
answer in Connecticut is your blood is almost certainly going to
stay in Connecticut. The reason that is, and why I am so certain of
that, is because we are a net importer of blood and what that means
is Connecticut does not supply enough blood products to support its
own hospitals right now.  As I mentioned earlier, we ship out
to hospitals of 165,000, and it is growing red cells each year, but
we only collect about 155,000 red cells each year and so if you
think about it, we have a gap to close. The only way is, as we keep
talking about, to have people call 1-800-GIVELIFE and make an
appointment. Come in, because quite frankly, we are being supported
by the good people of the mid west and the good people of upstate
New York whom regularly send us blood products.Snyder
People should realize that the donor base is very heavily dependent
on large industry because we used to be able to go to Pratt and
Whitney, for example, in North Haven, and have a blood drive there
daily for a week.  Then Pratt and Whitney closed in North
Haven and IBM shut down. When this industry changes or leaves the
state, a large numbers of donors leave as well.  So the
economic downturn that many states in the North East are suffering
has a direct impact on the unavailability of blood.  You
cannot get as much blood.  It is not as efficient from the
banking aspect to go to churches or schools and have 5, 6 or 8
people donate blood when that same effort could have been used at a
large factory to get large numbers. It is critical that people
realize that any donation, even at small drives, is critical. 
It is all added together and the Red Cross has had to change many
of their tactics in order to take advantage of that.Sullivan
 We still want people to come to the churches and we jokingly say,
"In everyone's face, every place," and it really does take that
kind of gorilla marketing mentality some days to get enough donors
to come out. It was, to a degree, an easier process when they had
large manufacturing operations in Connecticut, but those days are
gone.  We still have some and they are great supporters of us,
but what we really need is for people to get into the habit of
coming in and giving blood. I would encourage anyone out there who
owns a factory or any kind of small light industry to please
contact the Red Cross. Call 1-800-GIVELIFE.  We need more
sponsors as well.Miller
 After listening today I have to say I am feeling pumped about it;
I've donated before, but to donate again. You have made it really
clear to everyone just how important it is and I do not think we
want to be an importer anymore.  I think we want to be
self-sustaining.25:49 into mp3 file 
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The Red Cross has undergone a variety of changes at the national
level and one of the concerns was whether the Red Cross in
Connecticut was going to be here because they consolidate the same
way industry does.  To Paul Sullivan's credit and the national
Red Cross, we were able to make a case to keep the Red Cross in
Connecticut.  We wanted the blood to stay in the state,
because of a certain degree of pride or chauvinism. The Red Cross
understood that the Connecticut area is a small community and we
wanted the community blood to stay here. We are doing whatever we
can to ensure that this was a good move, both economically and
financially.  Many of the listeners out there understand that
a downturn of the economy, or the needs to consolidate, have an
impact on blood donation.  It is not just rolling up your
sleeves and throwing rose petals at everyone, it is an obligation
and it takes a lot of work behind the scenes.  Paul has been
at the Red Cross about three years and has done a superb job in
increasing the safety of the blood supply and the availability of
the blood supply, which has a direct effect on saving children's
lives and the people who need blood whenever they need it.Miller
 Who right now in the hospital may need a blood transfusion at
Yale?Snyder
As we speak we have about 40% of the 70,000 units we use a year go
to cancer patients.  People come to the clinic, and the
Yale-New Haven Smilow Cancer Hospital is being built. It will make
available the opportunity for people not to have to go to New York
or to Boston to get treated for cancer.  It expands the
ability for people to have treatment right here and the partnership
with the Red Cross is critical.  Cancer patients are receiving
about 40% of the blood, the other 30% to 40% are people having
vascular surgery for heart disease and other types of vascular
problems. Then there are acute emergencies and people that get
transfused for automobile accidents.Miller
 I have to say this has been a wonderful session.  I want to
thank Paul Sullivan and Dr. Ed Snyder for joining me and teaching
me and everyone else quite a bit about being a blood donor. 
Until next week, this is Dr. Ken Miller from the Yale Cancer Center
wishing you a safe and healthy week.