IN THE BLOOD: RIGOROUS TESTING HELPS KEEP THE BLOOD SUPPLY SAFE

A unit of whole blood, left, and at right, a unit of blood without plasma.

Nancy Wilson, a medical technologist at Southeast Hospital, examined plasma that is frozen at minus 30 degrees Celsius.

Blood was retested at Southeast Hospital to be sure the blood types are correct after they were received from the St. Louis Blood Bank.

Several times a month, volunteers have a chance to roll up their sleeves and take an hour out of their day to go to a high school gym or church hall and donate a pint of blood. Their efforts save lives.

To help make sure that donated blood is safe for accident victims, surgery patients and other recipients, the American Red Cross and other blood banks across the nation have adopted rigorous screening standards.

Donors go through "mini-physicals" during blood drives, including blood pressure and blood iron checks, said Pat Easton, "and we ask simple questions, such as, `Are you feeling well today?'"

The health screenings given during blood drives are the first step in keeping the blood supply safe, said Easton, manager of donor services for the American Red Cross' St. Louis district office, which covers 79 counties in Missouri and Illinois, including the Southeast Missouri region.

At the blood drive, donors are asked to complete a lengthy questionnaire about their general health and any medications they may be taking "so that we can determine through a series of questions whether it's safe for them to give and whether it's safe for the recipient," Easton said.

"If there's someone who is not eligible to give, we don't even take the blood," she added.

Some of the reasons for rejecting a donor are temporary: They may be taking antibiotics that week which make the blood unsuitable or they may have low blood iron, which could make donating blood dangerous for the donor.

"We have a book that's tremendously thick that tells us who can donate and who can't," Easton said.

And some red flags are more serious: The questionnaire may indicate the donor's lifestyle may put them at risk for diseases such as hepatitis or AIDS which can be transmitted through the donated blood.

If donors pass the initial screening and then decide after having given blood that their blood is unsuitable, there's a special "don't use" sticker they can affix to the blood bag. The sticker only features a bar code which will be scanned once the donated blood gets to a central location, Easton said.

All of the blood with the "don't use" stickers is discarded immediately.

"We try to do everything possible up front," Easton said.

Blood with the "do use" stickers is tested for indicators of several diseases, including HIV, hepatitis B and C, HTLV and syphilis.

If any screening shows positive for those diseases, confirmatory tests are run. If infection is confirmed, the donor is notified and advised to seek medical help.

But even if the screenings show a false-positive result, the blood unit is still discarded, Easton said.

"We do lose a lot of donors due to the testing procedures, and some of the donors could be very healthy, but we don't want to take a risk even on a false-positive," she said.

The public is probably most concerned about the possibility of donated blood being contaminated with HIV, the virus that causes AIDS, she said.

"The biggest transfusion problems probably come from hepatitis rather than HIV," she said. "Hepatitis is so prevalent, and a lot of people don't even know that they have that present. The risk is present, and it always has been."

Once the blood has been tested, it's sent out to regional blood banks, which keep hospitals supplied.

At the American Red Cross Cape Girardeau blood bank, 400 units of blood products -- whole blood, red blood cells, plasma, clotting factors and other components -- are maintained on a daily basis, said Peggy Kitchen, blood bank manager.

Each unit of blood is scanned again at the local office before being shipped to the 28 hospitals in the region, Kitchen said, just in case.

The American Red Cross tracks each unit of blood it receives, she said. Hospitals are responsible for keeping track of the final disposition of the blood products -- who receives what, and when and why.

"You can track the blood from the moment that the donors walk into the blood drive to the moment that it goes into a patient," Kitchen said. "Or if it's discarded, you can track that too."

The Cape Girardeau blood bank is inspected every year by the Food and Drug Administration to make sure that each of the components is properly stored and maintained and that proper records are kept.

"We have not had a citation in 10 years," Kitchen said.

Kitchen said she thinks the public has confidence in the blood supply's safety. Through the American Red Cross, patients with scheduled surgeries can opt to donate their own blood or ask friends and relatives to donate blood on their behalf in advance of the surgery.

Not many people take advantage of that, Kitchen said, which she considers a good sign of trust.

Once the blood product is at the hospital, the main concern is keeping it cold enough, said Marilyn Hughey, blood bank specialist at St. Francis Medical Center.

"That's to cut down on any chance of bacterial contamination because it's gotten too hot," she said. "It also helps preserve a lot of the factors in the blood."

Hospitals also have to follow standards outlining how soon a blood product has to be used, and how long that procedure can take, Hughey said.

If the hospital has to run blood tests on a patient, that sample is kept for 10 days after testing and then incinerated.