Blood donation 505536 222849366 2008-07-01T12:21:57Z DOI bot 6652755 Citation maintenance. Added: volume. Formatted: title, pages. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{redirect|Give blood}} [[Image:Blood donation at Fleet Week USA.jpg|thumb|A [[U.S. Navy]] [[Petty Officer]] donating blood.]] A '''blood donation''' is when a healthy person [[free will|voluntarily]] has [[blood]] drawn. The blood is used for [[blood transfusion|transfusions]] or made into medications by a process called [[fractionation#Plasma protein fractionation|fractionation]]. In the developed world, most blood donors are unpaid volunteers who give blood for a community supply. In poorer countries, established supplies are limited and donors usually give blood when family or friends need a transfusion. Many donors donate as an act of charity, but some are paid and in some cases there are incentives other than money. A donor can also have blood drawn for their own future use. Donating is relatively safe, but some donors have bruising where the needle is inserted or may feel faint. Potential donors are evaluated for anything that might make their blood unsafe to use. The screening includes testing for diseases that can be transmitted by a blood transfusion, including [[HIV]] and [[viral hepatitis]]. The donor is also asked about [[medical history]] and given a short [[physical examination]] to make sure that the donation is not hazardous to their health. How often a donor can give varies from days to months based on what they donate and the laws of the country where the donation takes place. The amount of blood drawn and the methods vary, but a typical donation is 500 milliliters of [[whole blood]]. The collection can be done manually or with automated equipment that only takes specific portions of the blood. Most of the components of blood used for transfusions have a short [[shelf life]], and maintaining a constant supply is a persistent problem. == Types of donation == Blood donations are divided into three groups based on who will receive the collected blood.<ref>M. E. Brecher, Editor (2005), ''AABB Technical Manual'', fifteenth edition, Bethesda, MD: AABB, ISBN 1-56935-19607, p.98-103</ref> An ''allogeneic'' (also called ''homologous'') donation is when a donor gives blood for storage at a [[blood bank]] for [[transfusion]] to an unknown recipient. A ''directed'' or ''replacement donor'' donation is when a person, often a family member, donates blood for [[transfusion]] to a specific individual.<ref>{{cite web|url=http://www.mayoclinic.org/donateblood/directed.html|title=Directed Donation|publisher=Mayo Clinic|accessdate=2008-06-25}}</ref> Directed donations are rare in developed countries like [[Canada]]<ref>{{cite journal|author=P.W. Wales ''et al''|title=Directed blood donation in pediatric general surgery: Is it worth it?|journal=Journal of Pediatric Surgery|volume=36|year=2001|pages=722–725|doi=10.1053/jpsu.2001.22945}}</ref> but are common in developing countries such as [[Ghana]].<ref name="PEPFAR Progress">T. Brown "Strengthening Blood Systems In Africa: Progress Under PEPFAR and Remaining Challenges" ''AABB News''. April, 1998:page 30</ref> The third kind is when a person has blood stored that will be transfused back to the donor at a later date, usually after surgery. This is called an ''[[autologous]]'' donation.<ref>{{cite web|url=http://www.aabb.org/Content/About_Blood/Facts_About_Blood_and_Blood_Banking/fabloodautoallo.htm|title=Autologous (self-donated) Blood as an Alternative to Allogeneic (donor-donated) Blood Transfusion|publisher=[[AABB]]|accessdate=2008-06-25}}</ref> Blood that is used to make medications can be made from allogeneic donations or from donations exclusively used for manufacturing.<ref>{{cite web|url=http://www.aabb.org/Content/Members_Area/Members_Area_Regulatory/Blood_Component_Preparation_and_Testing/plasbpac061302.htm|title=Recovered Plasma|publisher=[[AABB]]|accessdate=2008-06-25}}</ref> [[Image:Krwiodawstwo2.JPG|thumb|A blood collection in Poland. Blood banks sometimes use a modified bus or similar large vehicle to provide mobile facilities for donation.]] The actual process varies according to the laws of the country, and recommendations to donors vary according to the collecting organization.<ref name="australiatips">{{cite web| url=http://www.donateblood.com.au/page.aspx?IDDataTreeMenu=45&parent=31 | title=Giving Blood -> What to Expect | publisher=Australian Red Cross Blood Service| accessdate=2007-10-06}}</ref><ref name="canadatips">{{cite web|url=http://www.bloodservices.ca/centreapps/internet/uw_v502_mainengine.nsf/page/The%20Donation%20Experience?OpenDocument| title=The Donation Experience| publisher=Canadian Blood Services| accessdate=2006-12-17}}</ref><ref name="usarctips">{{cite web|url=http://www.givelife2.org/donor/tips.asp| title=Tips for a Good Donation Experience| publisher=American Red Cross| accessdate=2006-12-17}}</ref> The [[World Health Organization]] gives recommendations for blood donation policies,<ref>{{cite web|url=http://www.who.int/mediacentre/factsheets/fs279/en/|title = WHO Blood Safety and Donation|publisher = World Health Organization|accessdate=2008-06-01}}</ref> but in developing countries many of these are not followed. For example, proper testing requires laboratory facilities, trained staff, and specialized reagents, all of which may be not available or too expensive for developing countries.<ref name="WBDD 2006">{{cite web|url=http://www.who.int/mediacentre/news/releases/2006/pr33/en/index.html|title= World Blood Donor Day 2006|publisher=World Health Organization|accessdate=2008-06-26}}</ref> An event where donors come to give allogeneic blood is sometimes called a ''blood drive'' or a ''blood donor session''. These can occur at a blood bank but they are often set up at a location in the community such as a shopping center, workplace, school, or house of worship.<ref>{{cite web|url=http://www.givelife2.org/sponsor/|title=Sponsoring a Blood Drive|publisher=American Red Cross|accessdate=2008-06-25}}</ref> ==Screening== Donors are typically required to give [[informed consent|consent]] for the process and this requirement means that [[minor (legal)|minors]] cannot donate without parental consent.<ref>{{cite web|url=http://www.donateblood.com.au/admin%5Cfile%5Ccontent1%5Cc5%5Cwaconsent%20.pdf|format=pdf|title=example of a parental consent form|publisher=Australian Red Cross Blood Service|accessdate=2008-06-01}}</ref> In some countries, answers are associated with the donor's blood, but not name, to provide anonymity; in others, such as the United States, names are kept to create lists of ineligible donors.<ref>{{cite web|url=http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?fr=610.41|title=FDA regulations on donor deferral|accessdate=2008-06-01|publisher= US Food and Drug Administration}}</ref> If a potential donor does not meet these criteria, they are ''deferred''. This term is used because many donors that are ineligible may be allowed to donate later. The donor's race or ethnic background is sometimes important since certain [[human blood group systems|blood types]], especially rare ones, are more common in certain ethnic groups.<ref>{{cite web|url=http://query.nytimes.com/gst/fullpage.html?res=9C0CEEDC123DF930A25752C0A966958260|title=Donors' Races to Be Sought To Identify Rare Blood Types|publisher= New York Times|accessdate=2008-06-01}}</ref> Historically, donors were segregated or excluded on race, religion, or ethnicity, but this is no longer a standard practice.<ref>{{cite web|url=http://www.pbs.org/wnet/redgold/innovators/bio_drew.html|title = Red Gold, Innovators and Pioneers|publisher = Public Broadcasting Service (United States)|accessdate=2008-06-01}}</ref> ===Recipient safety=== Donors are screened for health risks that might make the donation unsafe for the recipient. Some of these restrictions are controversial, such as restricting donations from [[MSM blood donor controversy|men who have sex with men]] for [[HIV]] risk. [[Autologous]] donors are not always screened for recipient safety problems since the donor is the only person who will receive the blood.<ref>{{cite journal|title=The need for thorough infection screening in donors of autologous blood|url=http://www.ncbi.nlm.nih.gov/pubmed/1725645?ordinalpos=12&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum|journal=Beitr Infusionsther|year=1991|volume=28|author=M.U. Heim, W. Mempel}}</ref> Donors are also asked about medications such as [[dutasteride]] since they can be dangerous to a pregnant woman receiving the blood.<ref>{{cite web|url=http://www.fda.gov/cder/consumerinfo/druginfo/avodart.htm|title=Avodart consumer information|publisher=US Food and Drug Administration|accessdate=2008-06-01}}</ref> Donors are examined for [[medical sign|signs]] and [[symptoms]] of diseases that can be transmitted in a [[blood transfusion]], such as [[HIV]], [[malaria]], and [[viral hepatitis]]. Screening may extend to questions about [[risk factors]] for various diseases, such as travel to countries at risk for [[malaria]] or [[Creutzfeldt-Jakob disease#variant Creutzfeldt-Jakob Disease (vCJD)|variant Creutzfeldt-Jakob Disease (vCJD)]].<ref>{{cite web|url=http://www.fda.gov/cber/dhq/dhq11/dhq11a.htm|title=AABB Full-Length Donor History Questionnaire (UDHQ)|publisher=[[AABB]], [[FDA]]|accessdate=2008-06-25}}</ref> These questions vary from country to country. For example, [[Héma-Québec|Québec]] may defer donors who lived in the [[United Kingdom]] for risk of [[Creutzfeldt-Jakob disease#variant Creutzfeldt-Jakob Disease (vCJD)|vCJD]],<ref name="canadaCJD">{{cite web | title=Donor Qualification criteria | publisher=Héma-Québec, Canada |url=http://www.hema-quebec.qc.ca/anglais/dondesang/qualifidonneurs.htm | accessdate=2006-12-17}}</ref> but donors in the United Kingdom are only restricted if they have had a blood transfusion in the United Kingdom.<ref>{{Cite web|url=http://transfusionguidelines.org.uk/Index.aspx?Publication=RB&Section=25&pageid=546|title=Guidelines for UK Blood Services|accessdate=2008-06-01|publisher=UK Blood and Tissue Services}}</ref> ===Donor safety=== The donor is also [[physical exam|examined]] and asked specific questions about their medical history to make sure that donating blood isn't hazardous to their health. The donor's [[hematocrit]] or [[hemoglobin]] level is tested to make sure that the loss of blood will not make them [[anemic]], and this check is the most common reason that a donor is ineligible.<ref>{{cite web|url=http://www.ncbi.nlm.nih.gov/pubmed/17556020?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=5&log$=relatedarticles&logdbfrom=pubmed|title =Evaluation of four rapid methods for hemoglobin screening of whole blood donors in mobile collection settings.|publisher= National Institutes of Health|accessdate=2008-06-01}}</ref> [[Pulse]], [[blood pressure]], and [[body temperature]] are also evaluated. [[Elder]]ly donors are sometimes also deferred on age alone because of health concerns.<ref>{{cite journal|journal=Vox Sang|title=Effect of changing the age criteria for blood donors|author=M. Goldman ''et al''|year=2007|month=May|volume=92|pages=368–372}}</ref> The safety of donating blood during pregnancy has not been studied thoroughly and pregnant women are usually deferred.<ref>{{cite web|url=http://www.bloodbankofalaska.org/donating/faq.html|title=Donating - Frequently Asked Questions|accessdate=2008-06-01|publisher=Blood Bank of Alaska}}</ref> === Blood testing === A [[blood type]] is often determined by the agency that collects the blood, most frequently just [[ABO blood group system|A, B, AB, or O]], [[Rhesus blood group system|Rh type]] and screening for [[antibodies]] to rare blood types. The blood typing is sometimes repeated and more testing, including a [[crossmatch]], is usually done before a [[transfusion]]. Group O is often cited as the "universal donor"<ref>{{cite web|url=http://www.webmd.com/a-to-z-guides/blood-type-test|title=Blood Type Test|publisher=WebMD.com|accessdate=2008-06-01}}</ref> but this only refers to [[Red Blood Cells|red cell]] transfusions. For [[blood plasma|plasma]] transfusions the system is reversed and AB is the universal donor type.<ref>{{cite web|url=http://donatebloodnow.org/apheresis/docs/Plasma_Fact%20Sheet.pdf|title= Plasma fact sheet|publisher=American Red Cross}}</ref> Most blood is tested for diseases, including some [[Sexually transmitted disease|STD]]s.<ref>{{cite journal|url=http://www.wjgnet.com/1007-9327/13/3730.pdf|title=Significant increase in HBV, HCV, HIV and syphilis infections among blood donors in West Bengal, Eastern India 2004-2005|author=P. Bhattacharya ''et al''|journal=World Journal of Gastroenterology|volume=13|pages=3730–3733|year=2007|month=July}}</ref> The tests used are [[sensitivity (tests)|high-sensitivity screening tests]] and no actual diagnosis is made. Some of the test results are later found to be false positives using more [[specificity (tests)|specific testing]].<ref>{{cite web|url=http://www.aabb.org/Content/About_Blood/Facts_About_Blood_and_Blood_Banking/fabloodtesting.htm|title=Testing of Donor Blood for infectious disease|publisher=[[AABB]]|accessdate=2008-06-25}}</ref> [[Sensitivity (tests)|False negatives]] are rare, but donors are discouraged from using blood donation for the purpose of anonymous STD [[screening (medicine)|screening]] because a false negative could mean a contaminated unit. The blood is usually discarded if these tests are positive, but there are some exceptions, such as autologous donations. The donor is generally notified of the test result.<ref>{{cite journal |author=R. Miller, P.E. Hewitt, R. Warwick, M.C. Moore, B. Vincent |title=Review of counselling in a transfusion service: the London (UK) experience |journal=Vox Sang |volume=74 |issue=3 |pages=133–9 |year=1998 |pmid=9595639 |doi=10.1046/j.1423-0410.1998.7430133.x}}</ref> Donated blood is tested by many methods, but the core tests recommended by the World Health Organization are these four: *[[Hepatitis B]] Surface Antigen *Antibody to [[Hepatitis C]] *Antibody to [[HIV]], usually [[Subtypes of HIV|subtypes 1 and 2]] *Serologic test for [[Syphilis]] The WHO reported in 2006 that 56 out of 124 countries surveyed did not use these basic tests on all blood donations.<ref name="WBDD 2006">{{cite web|url=http://www.who.int/mediacentre/news/releases/2006/pr33/en/index.html|title= World Blood Donor Day 2006|publisher=World Health Organization|accessdate=2008-06-26}}</ref> A variety of other tests for [[transfusion transmitted infections]] are often used based on local requirements. Additional testing is expensive, and in some cases the tests are not implemented because of the cost.<ref>{{cite web|url=http://www.advisorybodies.doh.gov.uk/acmsbtt/msbtsum280605.pdf|title=Advisory Committe on MSBTO, 28 June 2005|accessdate=2008-06-01}}</ref> These additional tests include other infectious diseases such as [[West Nile Virus]].<ref name="westnile">{{cite web | title=Precautionary West Nile virus blood sample testing| | publisher=Héma-Québec, Canada | url=http://www.hema-quebec.qc.ca/anglais/centredepresse/coms2005/20050808.htm | accessdate=2006-12-17}}</ref> Sometimes multiple tests are used for a single disease to cover the limitations of each test. For example, the [[HIV]] antibody [[HIV test|test]] will not detect a recently infected donor, so some blood banks use a [[p24 antigen]] or [[Nucleic acid test|HIV nucleic acid]] test in addition to the basic antibody test to detect infected donors during that period. [[Cytomegalovirus]] is a special case in donor testing in that many donors will test positive for it.<ref name="Circular of Information">{{cite web|url=http://www.aabb.org/Documents/About_Blood/Circulars_of_Information/coi0702.pdf|title=Circular of Information for use of Blood and Blood Products|publisher=[[AABB]], [[ARC]], [[America's Blood Centers]]|format=pdf}}</ref> The virus is not a hazard to a healthy recipient, but it can harm infants<ref name="neonatal-rbc1">{{cite web|url=http://www.cps.ca/english/statements/fn/fn02-02.htm#What%20type%20of%20RBCs%20should%20be%20used |title=Red blood cell transfusions in newborn infants: Revised guidelines |publisher=Canadian Paediatric Society (CPS) |accessdate=2007-02-02}}</ref> and other recipients with weak immune systems.<ref name="Circular of Information"> test </ref> ==Obtaining the blood== [[Image:Blood donation needle.jpg|thumb|300px|A donor's arm at various stages of donation. The two photographs on the left show a blood pressure cuff being used as a tourniquet.]] There are two main methods of obtaining blood from a donor. The most frequent is simply to take the blood from a vein as [[whole blood]]. This blood is typically further processed into components, such as [[red blood cells]] and [[blood plasma|plasma]]. The other method is to draw blood from the donor, separate it using a [[centrifuge]] or a filter, store the desired part, and return the rest to the donor. This process is called [[apheresis]], and it is often done with a machine specifically designed for this purpose. For direct [[transfusions]] a vein can be used but the blood may be taken from an [[artery]] instead.<ref>{{cite journal|journal=European Journal of Pediatrics|volume=137|month=November|year=1981|author=F. Sagi ''et al''|title= Exchange transfusion in newborns via a peripheral artery and vein|url=http://www.springerlink.com/content/u18xn2491012nr8x/|doi= 10.1007/BF00443258|pages= 283}}</ref> In this case, the blood is not stored and is pumped directly from the donor into the recipient. This was the original method for blood transfusion and is rarely used in modern practice.<ref>{{cite web |url=http://www.pbs.org/wnet/redgold/basics/bloodonhoof.html |title=Blood on the Hoof|publisher=Public Broadcasting Service |accessdate=2008-06-25}}</ref> It is an option in emergent contexts where the normal blood supply is overwhelmed (war, natural disasters). ===Site preparation and drawing blood=== The blood is typically drawn from the [[median cubital vein]] on the inside of the elbow or from any other easily accessible large arm [[superficial vein|vein close to the skin]]. The skin over the blood vessel is cleaned with an [[antiseptic]], usually [[iodine]] or [[chlorhexidine]],<ref name="CKL arm prep">{{cite journal|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1423-0410.2002.00219.x|title=Impact of donor arm skin disinfection on the bacterial contamination rate of platelet concentrates|journal=Vox Sang|author=C.K. Lee ''et al''| year=2002| month=October| volume=83| pages=204–208| doi=10.1046/j.1423-0410.2002.00219.x}}</ref> to prevent skin bacteria from contaminating the collected blood,<ref name="CKL arm prep">{{cite journal|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1423-0410.2002.00219.x|title=Impact of donor arm skin disinfection on the bacterial contamination rate of platelet concentrates |journal=Vox Sang |author=C.K. Lee ''et al'' |year=2002| month=October| volume=83| pages=204–208| doi=10.1046/j.1423-0410.2002.00219.x}}</ref> and also to prevent infections starting at the site where the needle pierced the donor's skin.<ref>{{cite book |author=M. L. Turgeon|title=Clinical Hematology: Theory and Procedures |url= http://books.google.com/books?id=v2iyQBKx00kC&pg=PA30&lpg=PA30&dq=phlebotomy+complications&source=web&ots=GSRbgp8ydH&sig=T4APht_sZdr-zDtw0BfNu6vD-zU&hl=en&sa=X&oi=book_result&resnum=6&ct=result#PPA30,M1 |accessdate= 2008-06-21 |edition= fourth |year= 2004 |publisher= Lippincott Williams & Wilkins |isbn= 0781750075 |pages= 30}}</ref> A large [[hypodermic needle|needle]] such as a 16 [[Hypodermic needle#Needle gauge|gauge]]<ref>{{cite web|url=http://www.genesisbps.com/PDF/blood_bags_terumo.pdf|title=Blood banking laboratory supplies|publisher=Genesis BPS|accessdate=2008-06-01}}</ref> (1.651 mm) is used to minimize [[shearing (physics)|shearing]] forces that may physically [[hemolysis|damage]] red blood cells as they flow through the needle.<ref>{{cite web|url= http://www.bd.com/vacutainer/pdfs/techtalk/TechTalk_Jan2004_VS7167.pdf| title=What is Hemolysis?|accessdate=2008-06-01|publisher= [[Becton-Dickinson]]}}</ref> The [[flow rate|flow]] of blood from a vein into the needle and down tubing into the collection bag is mainly by the pull of gravity; however, in addition a [[tourniquet]] is usually lightly wrapped around the upper arm to increase the [[Blood pressure#Venous pressure|pressure of the blood in the arm veins]] and the donor may also be prompted to hold an object and squeeze it repeatedly to [[skeletal-muscle pump|increase the blood flow]] through the vein. ===Whole blood=== [[Image:Blood Donation 12-07-06 2.JPG|thumb|A mechanical tray agitates the bag to mix the blood with anticoagulants and prevent clotting.]] The most common method is collecting the blood from the donor's vein into a container. The amount of blood drawn varies from 200 milliliters to 550 milliliters depending on the country, but 450-500 milliliters is typical.<ref name="Circular of Information">{{cite web|url=http://www.aabb.org/Documents/About_Blood/Circulars_of_Information/coi0702.pdf|title=Circular of Information for use of Blood and Blood Products|publisher=[[AABB]], [[ARC]], [[America's Blood Centers]]|format=pdf}}</ref> The blood is usually stored in a plastic bag that also contains [[sodium citrate]], [[phosphate]], [[dextrose]], and sometimes [[adenine]]. This combination keeps the blood from clotting and preserves it during storage.<ref>{{cite journal|journal=Vox Sang|author=O. Aberklom, A. Kreuger|title=Studies on citrate-phosphate-dextrose (CPD) blood supplemented with adenine|url=http://www.ncbi.nlm.nih.gov/pubmed/238338?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed|year=1975|volume=29|pages=90–100}}</ref> Other chemicals are sometimes added during [[Whole blood#Processing|processing]]. The plasma from whole blood can be used to make [[blood plasma#Fresh frozen plasma and other transfused plasmas|plasma for transfusions]] or it can also be processed into other medications using a process called [[fractionation]]. This was a development of the [[blood plasma#Dried plasma|dried plasma]] used to treat the wounded during [[World War II]] and variants on the process are still used to make a variety of other medications.<ref>{{cite web|url=http://history.amedd.army.mil/booksdocs/wwii/blood/chapter7.htm|title=Plasma Equipment and Packaging, and Transfusion Equipment|publisher=Office of Medical History ([[OTSG]])|accessdate=2008-06-19}}</ref> <ref>{{cite web|url=http://www.sanquin.nl/Sanquin-eng/sqn_From_blood_to_medicine.nsf/All/Plasma-Fractionation---Medicines-Derived-From-Plasma.html|title=Medicines derived from human plasma|publisher=Sanquin Blood Supply Foundation|accessdate=2008-06-01}}</ref> ===Apheresis=== {{Main|apheresis|plasmapheresis|plateletpheresis}} [[Image:Blood Donation 12-07-06 1.JPG|thumb|A relatively large needle is used for blood donations.]] Usually the component returned is the red blood cells, the portion of the blood that takes the longest to replace. Using this method an individual can donate [[plasmapheresis|plasma]] or [[Plateletpheresis|platelets]] much more frequently than they can safely donate whole blood. These can be combined, with a donor giving both plasma and platelets in the same donation. [[Platelets]] can also be separated from [[whole blood]], but they must be pooled from multiple donations. From three to ten units of whole blood are required for a [[therapeutic dose]].<ref>{{cite web|url=http://www.scbcinfo.org/publications/bulletin_v2_n2.htm|title=Indications for Platelet Transfusion Therapy|publisher=Southeastern Community Blood Center|accessdate=2008-06-10}}</ref> Plateletpheresis provides at least one full dose from each donation. [[Plasmapheresis]] is frequently used to collect [[source plasma]] that is used for manufacturing into medications much like the plasma from whole blood. Plasma collected at the same time as plateletpheresis is sometimes called ''concurrent plasma''. Apheresis is also used to collect more red blood cells than usual in a single donation and to [[leukapheresis|collect white blood cells]] for transfusion.<ref name="dblred-ubs">{{cite web|url = http://www.unitedbloodservices.org/automation.html|title = "Double Up to Save Lives"|publisher = [[United Blood Services]]|accessdate = 2007-02-23}}</ref><ref name="dblred-arccpr">{{cite web| url = http://www.my-redcross.org/index.cfm/p/Double-Red-Cell| title = "Double the Difference"| publisher = [[American Red Cross]] (Greater Chesapeake and Potomac)| accessdate = 2007-02-23}}</ref> ==Recovery and time between donations== Donors are usually kept at the donation site for 10-15 minutes after donating since most adverse reactions take place during or immediately after the donation. <ref>{{cite journal|title=Adverse Reactions to Allogeneic Whole Blood Donation by 16- and 17-Year-Olds|journal=Journal of the American Medical Association|year=2008|volume=299|pages=2279–2286|author=Eder et al.|doi=10.1001/jama.299.19.2279|pmid=18492969}}</ref> The needle site is covered with a [[bandage#compression bandage|bandage]] and the donor is directed to keep the bandage on for several hours.<ref>{{cite web|url= http://www.mayoclinic.com/health/blood-donation/GA00039|title=Blood donation: what to expect|publisher=Mayo Clinic|accessdate=2008-06-01}}</ref> Plasma is replaced after 2-3 days.<ref>{{cite web|url=http://www.cbccts.org/donating/automated.htm|title=Donating Apheresis and Plasma|publisher=Community Blood Center|accessdate=2008-06-11}}</ref> Red blood cells are replaced by bone marrow into the circulatory system at a slower rate, on average 36 days in healthy adult males.<ref>{{cite journal|journal=Transfusion|author=T Pottgiesser|year=2008|month=may|url=http://www.ncbi.nlm.nih.gov/pubmed/18466177|title=Recovery of hemoglobin mass after blood donation|doi=10.1111/j.1537-2995.2008.01719.x|volume=0|pages=080506061010191}}</ref> A donor effectively burns about 650 [[calorie (food)|calories]] by donating one pint of blood.<ref name="donate blood">{{cite web | title =Donate Blood - Frequently Asked Questions | publisher=Mayo Clinic| url=http://www.mayoclinic.org/donateblood/know.html | accessdate=2007-11-27}}</ref> Blood centers typically provide light refreshments such as tea and biscuits or something similar. For example, donors in Latvia receive a lunch allowance.<ref>{{cite web|url=http://siba2.unile.it/ese/issues/288/660/RelazDonazSanguigne_p6.pdf| title=Report on the promotion by Member States of voluntary unpaid blood donation|publisher=Commission of the European Communities|accessdate=2008-06-26}}</ref> These replacement rates are the basis of how frequently a donor can give blood. [[Plasmapheresis]] and [[plateletpheresis]] donors can give much more frequently, though the exact rate differs from country to country. For example, plasma donors in the United States are allowed to donate large volumes twice a week and could nominally give 83 liters in a year, whereas the same donor in Japan may only donate every other week and could only donate about 16 liters in a year.<ref>{{cite web|url=http://www.fda.gov/ohrms/dockets/ac/03/transcripts/4014T2.htm|title=Blood Products Advisory Committee, 12 December 2003|accessdate=2008-06-01}}</ref> Red blood cells are the limiting step for whole blood donations, and the frequency of donation varies widely. In Hong Kong it is from three to six months,<ref>{{cite web|url=http://www5.ha.org.hk/rcbts/e_donation.html|title=Blood Donation|publisher=Hong Kong Red Cross Blood Transfusion Service|accessdate=2008-06-01}}</ref> in Australia it is twelve weeks,<ref>{{cite web|url=http://www.donateblood.com.au/page.aspx?IDDataTreeMenu=48&parent=31|title=Before and after giving blood|publisher=Australian Red Cross Blood Service|accessdate=2008-06-01}}</ref> and in the United States it is 56 days (eight weeks).<ref>{{cite web|url=http://www.lmbb.org/whole_blood.html|title=Donating Whole Blood|publisher=Lane Memorial Blood Bank|accessdate=2008-06-01}}</ref> ==Complications== Donors are screened for health problems that would put them at risk for serious complications from donating. First-time donors, teenagers, and women are at a higher risk of a reaction.<ref name="pmid18492969">{{cite journal |author=A.F. Eder, C.D. Hillyer, B.A. Dy, E.P. Notari, R.J. Benjamin |title=Adverse reactions to allogeneic whole blood donation by 16- and 17-year-olds |journal=JAMA |volume=299 |issue=19 |pages=2279–86 |year=2008 |month=May |pmid=18492969 |doi=10.1001/jama.299.19.2279 |url=http://jama.ama-assn.org/cgi/content/full/299/19/2279}}</ref><ref name="pmid18346014">{{cite journal |author=S. Yuan, J. Gornbein, B. Smeltzer, A.F. Ziman, Q. Lu, D. Goldfinger |title=Risk factors for acute, moderate to severe donor reactions associated with multicomponent apheresis collections |journal=Transfusion |volume= 48|issue= |pages= 1213|year=2008 |month=March |pmid=18346014 |doi=10.1111/j.1537-2995.2008.01674.x}}</ref> One study showed that 2% of donors had an adverse reaction to donation.<ref>{{cite web|url=http://www.redcross.or.th/extra/blood_seminar_50/files/211_1525-1536.pdf|title=Adverse Effect of Blood Donation, Siriraj Experience|publisher=American Red Cross|accessdate=2008-06-01}}</ref> Most of these reactions are minor. A study of 194,000 donations found only one donor with long-term complications.<ref>{{cite journal | author = B. Newman, S. Graves | title = A study of 178 consecutive vasovagal syncopal reactions from the perspective of safety | journal = Transfusion | volume = 41 | issue = 12 | pages = 1475–9 | year = 2001 | pmid = 11778059 | doi = 10.1046/j.1537-2995.2001.41121475.x}}</ref> In the United States, a blood bank is required to report any death that might possibly be linked to a blood donation. An analysis of all reports from October 2004 to September 2006 evaluated 22 events and found no deaths related to donation, though one could not be ruled out.<ref>{{cite web|url=http://www.fda.gov/Cber/blood/fatal0506.htm#g|title=Fatalities Reported to FDA|publisher=US Food and Drug Administration|accessdate=2008-06-01}}</ref> [[Image:P1000494.jpg|thumb|right|Slight bruising on the arm from the donation needle; shown 24 hours after donation]] [[Hypovolemia|Hypovolemic]] reactions can occur because of a rapid change in [[blood pressure]]. Fainting is generally the worst problem encountered.<ref>{{cite journal|url=http://www.ncbi.nlm.nih.gov/pubmed/18482188?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum|title=Faint and prefaint reactions in whole-blood donors: an analysis of predonation measurements and their predictive value|journal=Transfusion|year=2008|month=May|author=T.B. Wiltbank ''et al''|doi=10.1111/j.1537-2995.2008.01745.x|volume=0|pages=080514102345979}}</ref> The process has similar risks to other forms of [[phlebotomy]]. Bruising of the arm ([[hematoma]]) from the needle insertion is the most common concern. One study found that less than 1% of donors had this problem.<ref name="bruising">{{cite journal|title=Bruising following blood donation|author=E. Ranasinghe, J.F. Harrison|url=http://www.ncbi.nlm.nih.gov/pubmed/10849380?dopt=Abstract | publisher=Transfus Med|year=2000|month=June|volume=10|pages=113–6|accessmonthday=December 17 | accessyear=2006 }} </ref> Donors sometimes have adverse reactions to the [[sodium citrate]] used in [[apheresis]] collection procedures to keep the blood from clotting. Since the anticoagulant is returned to the donor along with blood components that are not being collected, it can bind the [[calcium]] in the donor's blood and cause [[hypocalcemia]].<ref>{{cite journal|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1537-2995.2001.41091165.x|title=Comprehensive analysis of citrate effects during plateletpheresis in normal donors|author=C.D. Bolan ''et al''|journal=Transfusion|volume=41|issue=9|pages=1165–1171|year=2001|month=September|doi=10.1046/j.1537-2995.2001.41091165.x}}</ref> These reactions tend to cause tingling in the lips, but may cause convulsions or more serious problems. Donors are sometimes given calcium supplements during the donation to prevent these side effects.<ref>{{cite web|url=http://www.redcross.org/services/biomed/0,1082,0_543_,00.html|title=Jerome H. Holland Laboratory for the Biomedical Sciences Volunteer Research Blood Program (RBP)|publisher=American Red Cross|accessdate=2008-06-01}}</ref> In [[apheresis]] procedures, the [[red blood cells]] are often returned. If this is done manually and the donor receives the blood from a different person, a [[transfusion reaction]] can take place. Manual apheresis is extremely rare in the developed world because of this risk and automated procedures are as safe as whole blood donations.<ref>{{cite journal|author=T.B. Wiltbank, G.F. Giordano|title=The safety profile of automated collections: an analysis of more than 1 million collections|journal=Transfusion|volume=47|year=2007|month=June|doi=10.1111/j.1537-2995.2007.01224.x|pages=1002}}</ref> The final risk to blood donors is from equipment that has not been properly [[sterilized]]. This is not a concern in developed countries such as [[Ireland]] since all of the equipment that comes in contact with blood is disposed after use.<ref>{{cite web|url=http://www.ibts.ie/generic.cfm?mID=2&sID=9|title=Blood Donor Information Leaflet|publisher=Irish Blood Transfusion Service|accessdate=2008-06-01}}</ref> It was a significant problem in [[China]] in the 1990s, and up to 250,000 blood plasma donors may have been infected with HIV from shared equipment.<ref>{{cite web|url=http://www.usembassy-china.org.cn/sandt/webaids5.htm|title=Keeping China's blood supply free of HIV|publisher=US Embassy, Beijing|accessdate=2008-06-01}}</ref><ref>{{cite web|url=http://www.sciencemag.org/cgi/content/summary/304/5676/1438|title=HIV/AIDS IN CHINA: An Unsafe Practice Turned Blood Donors Into Victims|publisher=[[Science (magazine)|Science]]|accessdate=2008-06-01}}</ref> ==Storage, supply and demand== The collected blood is usually stored as separate components, and some of these have short shelf lives. There are no storage solutions to keep platelets for extended periods of time, though some are being studied as of 2008,<ref>{{cite web|url=http://www.ingentaconnect.com/content/bsc/trans/2006/00000016/A00101s1/art00057|title=In Vitro Evaluation of Buffy Coat Derived Platelet Concentrates in SSP+ Platelet Storage Medium|publisher=Transfusion Medicine (Blackwell Publishing|accessdate=2008-06-01}}</ref> and the longest shelf life used is seven days.<ref>{{cite web|url=http://transfusionguidelines.org.uk/index.asp?Publication=HTM&Section=9&pageid=1106|title=Transfusion Handbook, summary information for Platelets|publisher=National Blood Transfusion Committee|accessdate=2008-06-02}}</ref> Red blood cells, the most frequently used component, have a shelf life of 35-42 days at refrigerated temperatures.<ref>{{cite web|url=http://www.ingentaconnect.com/content/bsc/trf/2003/00000043/00000011/art00005|title=Effects of rejuvenation and frozen storage on 42-day-old AS-3 RBCs|publisher=Transfusion (Blackwell Publishing|accessdate=2008-06-01}}</ref><ref>{{cite web|url=http://transfusionguidelines.org.uk/Index.aspx?Publication=HTM&Section=9&pageid=1105|title=Transfusion handbook, Summary information for Red Blood Cells|accessdate=2008-06-02|publisher=National Blood Transfusion Committee}}</ref> This can be extended with by freezing with a mixture of [[glycerol]]<ref name="Circular of Information">{{cite web|url=http://www.aabb.org/Documents/About_Blood/Circulars_of_Information/coi0702.pdf|title=Circular of Information for use of Blood and Blood Products|publisher=[[AABB]], [[ARC]], [[America's Blood Centers]]|format=pdf}}</ref> but this process is expensive, rarely done, and requires an extremely cold freezer for storage. Plasma can be stored frozen for an extended period of time and is typically given an expiration date of one year<ref>{{cite web|url=http://agmed.sante.gouv.fr/ang/pdf/glffpl.pdf|title=Transfusion of Fresh Frozen Plasma, products, indications|publisher=Agence française de sécurité sanitaire des produits de santé|accessdate=2008-06-02}}</ref> and maintaining a supply is less of a problem. The limited storage time means that it is difficult to have a stockpile of blood to prepare for a disaster. The subject was discussed at length after the [[September 11th attacks]] in the United States, and the consensus was that collecting during a disaster was impractical and that efforts should be focused on maintaining an adequate supply at all times.<ref>{{cite web|url=http://www.gao.gov/new.items/d021095t.pdf|title=Maintaining an Adequate Blood Supply Is Key to Emergency Preparedness|publisher=[[Government Accountability Office]]|accessdate=2008-06-01}}</ref> Blood centers in the U.S. often have difficulty maintaining even a three day supply for routine transfusion demands.<ref>{{cite web|url=http://members.americasblood.org/plsql/ecat/supply_monitor_pkg.web_report|title=Current status of America's Blood Centers blood supply|publisher=America's Blood Centers}}</ref> The [[World Health Organization]] recognizes World Blood Donor Day on 14<sup>th</sup> June each year to promote blood donation. This is the birthday of [[Karl Landsteiner]], the scientist that discovered the [[ABO blood group system]].<ref>{{cite web|url=http://www.wbdd.org/index.php?id=24|title=World Blood Donor Day|publisher=World Health Organization|accessdate=2008-06-01}}</ref> ==Benefits and incentives== The World Health Organization set a goal in 1997 for all blood donations to come from unpaid volunteer donors,<ref name="WBDD 2006">{{cite web|url=http://www.who.int/mediacentre/news/releases/2006/pr33/en/index.html|title= World Blood Donor Day 2006|publisher=World Health Organization|accessdate=2008-06-26}}</ref> but as of 2006, only 49 of 124 countries surveyed had established this as a standard. [[Plasmapheresis]] donors in the [[United States]] are still paid for donations.<ref>{{cite web|url=http://www.gao.gov/archive/1998/he98205.pdf|title=Blood Plasma Safety|publisher=[[GAO]]|accessdate=2008-06-01}}</ref> A few countries rely on paid donors to maintain an adequate supply.<ref>{{cite journal|title=Safety of the Blood Supply in Latin America|url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=544183&rendertype=abstract|year=2005|month=January|journal=Clinical Microbiology Reviews|author=G. A. Schmunis (corresponding author for [[PAHO]])|pmid=15653816|doi=10.1128/CMR.18.1.12-29.2005|volume=18|pages=12}}</ref> Some countries, such as [[Tanzania]], have made great strides in moving towards this standard, with 20 percent of donors in 2005 being unpaid volunteers and 80 percent in 2007,<ref name="PEPFAR Progress">T. Brown "Strengthening Blood Systems In Africa: Progress Under PEPFAR and Remaining Challenges" ''AABB News''. April, 1998:page 30</ref> but 68 of 124 countries surveyed by WHO had made little or no progress. In some countries, for example [[Brazil]],<ref>L. Fusco "From Latin America to Asia, Rising Above Difficulties, Achieving New Heights" ''AABB News''. April, 1998:page 30</ref> it is against the law to receive any compensation, monetary or otherwise, for the donation of blood or other human tissues. In patients prone to iron overload, blood donation prevents the accumulation of toxic quantities.<ref>{{cite journal|url=http://www.ncbi.nlm.nih.gov/pubmed/15373512|title=Hemochromatosis, iron, and blood donation: a short review|journal=Immunohematology|year=1999|volume=15|pages=108–112}}</ref> Blood banks in the United States must label the blood if it is from a therapeutic donor, so most do not accept donations from donors with any blood disease.<ref name="hemochromatosis guidance">{{cite web | title =Variances for Blood Collection from Individuals with Hereditary Hemochromatosis | publisher=US Food and Drug Administration | url=http://www.fda.gov/cber/gdlns/hemchrom.htm | accessdate=2007-07-18}}</ref> Others, such as the [[Australian Red Cross Blood Service]], accept blood from donors with [[hemochromatosis]]. It is a genetic disorder that does not affect the safety of the blood.<ref>{{cite web|title=Hereditary Hemochromatosis: Perspectives of Public Health, Medical Genetics, and Primary Care|url=http://www.cdc.gov/genomics/training/perspectives/other/hfe.htm|accessdate=2008-06-03|publisher=CDC Office of Public Health Genomics}}</ref> Donating blood may reduce the risk of heart disease for men,<ref name="heartdisease">{{cite web | title=Cohort study of relation between donating blood and risk of myocardial infarction in 2682 men in eastern Finland |url=http://bmj.bmjjournals.com/cgi/content/full/314/7083/793 | publisher=[[British Medical Journal|BMJ]] | accessdate=2006-12-17}} </ref> but the link has not been firmly established. Other incentives are sometimes added by employers, usually time off for the purposes of donating.<ref>{{cite web|url=http://www.labor.state.ny.us/workerprotection/laborstandards/PDFs/Blood%20guidelinesFINAL.pdf|title=Guidelines for Implementation of Employee Blood Donation Leave|publisher=New York State Department of Labor|accessdate=2008-06-01}}</ref> Blood centers will also sometimes add incentives such as assurances that donors would have priority during shortages or other programs, prize drawings for donors and rewards for organizers of successful drives.<ref>{{cite web|url=http://www.bloodct.org/announcements.php|title=Incentives program for blood donors and organizers|publisher=American Red Cross Connecticut Blood Services Region|accessdate=2008-06-01}}</ref> Most allogeneic blood donors donate as an act of charity and do not expect to receive any direct benefit from the donation.<ref>{{cite journal|title=The role of altruistic behavior, empathetic concern, and social responsibility motivation in blood donation behavior|author=W.R. Steele ''et al.''|year=2008|month=January|journal=Transfusion|volume=48}}</ref> ==See also== * [[List of blood donation agencies]] * [[Blood transfusion]] * [[Plateletpheresis]] * [[Bloodletting]] == References == {{reflist}} ==Further reading== {{commons|Blood#Blood donation|Blood donation}} * [http://library.med.utah.edu/WebPath/TUTORIAL/BLDBANK/BBPROC.html Blood Donation and Processing] * [http://transfusionguidelines.org.uk/ British guidelines for transfusion medicine] * {{cite news | author=Emily Harrison | coauthors=Cary Wolinsky | title=Blood Cells for Sale | url= | format=print | work=[[Scientific American]] | publisher=Scientific American, Inc. | pages= 108&ndash;109 | date=November 2007 | accessdate=2008-06-28 | quote=(subtitle) There's more to blood banking than just bagging blood }} {{transfusion medicine}} {{Donation}} [[Category:Donation]] [[Category:Giving]] [[Category:Blood]] [[Category:Blood products]] [[Category:Transfusion medicine]] [[Category:Hematology]] [[bg:Кръводаряване]] [[cs:Darování krve]] [[da:Bloddonor]] [[de:Blutspende]] [[es:Donación de sangre]] [[fr:Don de sang]] [[ko:헌혈]] [[id:Donor darah]] [[it:Donazione del sangue]] [[he:תרומת דם]] [[lt:Kraujo donorystė]] [[nl:Bloeddonatie]] [[ja:献血]] [[no:Blodgivning]] [[pa:ਖੂਨ ਦਾਨ]] [[pl:Krwiodawstwo]] [[pt:Doação de sangue]] [[ru:Донорство крови]] [[sk:Darovanie krvi]] [[fi:Verenluovutus]] [[sv:Blodgivning]] [[ta:இரத்த தானம்]] [[th:การบริจาคโลหิต]] [[bat-smg:Krauja donorīstė]] [[zh:无偿献血]]