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New blood transfusion standards change donation landscape

New Hampshire Union Leader

August 25. 2014 8:11PM
Blood storage boxes are ready for Tuesday and Wednesday's 31st Annual Gail Singer Memorial Blood Drive at the Radisson in Manchester. (DAVID LANE/UNION LEADER)

MANCHESTER — The two-day Gail Singer Memorial Blood Drive begins in downtown Manchester Tuesday, and while it will likely remain New England’s largest blood drive, it takes place as the need for blood transfusions is falling off.

Hospitals are placing fewer orders for blood products from regional blood banks and are demanding more specialized products. The Red Cross has laid off workers at some blood banks nationally, the organization acknowledged.

And blood banks are looking closely at a donor’s blood type to obtain a blood product that is still in demand.

“It’s getting harder for blood suppliers because there is a reduction in demand,” said Dr. Nancy Dunbar, medical director of the blood bank at Dartmouth-Hitchcock Medical Center, which cut back on outside blood purchases two years ago.

“There’s a surplus that works in our favor as a customer,” Dunbar said.

The Singer blood drive is named after Gail Singer, who died in 1984 of leukemia at the age of 29. In the last 15 years, the drive has collected more than 9,000 pints.

On its website, the blood drive says that 38,000 pints of blood are needed nationally each day.

“It’s just simply an outdated figure that is still floating around,” said Mary Brant, spokesman for the Northern New England Red Cross.

This year the Red Cross needs less than half that — 15,000 pints a day on a national basis.

The Red Cross issued a statement Monday that confirmed a reduction in demand for blood products.

“Overall demand for blood products has dropped as medical treatments advance and fewer transfusions are necessary, and the Red Cross and other blood banking organizations continue to look for ways to respond,” reads the statement, issued by Stephanie Millian, national spokesman for American Red Cross Biomedical Services.

But the Red Cross said accident victims, cancer patients and children with blood disorders need blood, and that need can only be met by voluntary donations.

New transfusion standard

At Dartmouth-Hitchcock, the big change came in October 2012, when the hospital adopted a new standard for transfusion. Earlier that year, the American Association of Blood Banks recommended transfusions when a patient’s hemoglobin level dropped to 7 grams per deciliter, Dunbar said.

Doctors had previously ordered transfusions at higher levels — sometimes 9 or even 10 grams per deciliter, Dunbar said. The hospital ended up throwing away blood that exceeded the 42-day shelf life, she said.

In another trend, surgery is less bloody. Laparoscopic surgery means smaller incisions, and even invasive surgeries such as open-heart and organ transplants use less blood, Dunbar said.

Dartmouth-Hitchcock surgeons use a “cell salvage” technique that removes, cleans and re-infuses the blood that a patient spills in surgery, Dunbar said. Transplants can now be accomplished with one to two pints of blood, she said.

At Catholic Medical Center in Manchester, the hospitals empaneled a transfusions committee years ago when blood was in short supply, said hospital spokesman Sue Manning.

The hospital adopted the lower hemoglobin standard in 2009, and said transfusions dropped by 10 to 15 percent.

Dunbar said Dartmouth-Hitchcock is relying more on its own blood bank to provide blood for the hospital. And when it purchases blood, it can reach far outside the two regional providers in Burlington, Vt., and Dedham, Mass., in part because blood products can be shipped.

By blood type

Dunbar said hospitals are demanding specialized testing and products from blood banks. She said her blood bank never turns anyone away, and first-time donors are always asked to give a unit of red blood cells, the traditional blood collected at blood drives.

But repeat donors are encouraged to give where the need is greatest. Donors with Type O blood will always be asked to donate red cells.

Others may be encouraged to give platelets. Three hours are needed to collect a unit of platelets, which are the clotting factor in blood. A unit of platelets has a shelf life of five days, and it’s needed for emergency room-type trauma and patients undergoing treatment for leukemia and bone-marrow cancer.

Dartmouth-Hitchcock collects 80 units of platelets a month, compared to 50 of red blood cells.

In the Red Cross statement, Millian said blood banks are coming to terms with the decreased demand. While the statement doesn’t mention the term layoffs or work force reductions, the Red Cross said it has undertaken “cost-saving actions” and offered severance packages and outplacement services to workers.

Sixty-eight workers at the Manchester-based blood bank are represented by the United Auto Workers. Ellen Wallace, a regional director who works with the UAW local that represents the blood bank workers, said she knows of no layoffs there, and said a worker was recently added.

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