http://www.usatoday.com/usatonline/20030630/5284451s.htm

Safety rules drain blood banks As new diseases arise, the screening process grows, and more donors are turned away

By Anita Manning
USA TODAY

SAN FRANCISCO -- Blood banks have long struggled to meet the high demand for blood, but they fear that a wave of new regulations that prohibit many categories of Americans from donating could result in major shortages that could be felt as soon as this Fourth of July weekend.

The holiday is usually a tough time for the nation's blood supply, because donors go off to the beach or mountains at the same time holiday accidents create more demand for blood.

But this year could be worse than usual, blood experts say, because people who are willing to roll up their sleeves and give blood are increasingly being turned away for safety reasons. Blood banks could face unprecedented shortages in the coming weeks and months, those experts fear.

As new diseases like SARS and West Nile emerge, posing potential threats to Americans and their blood supply, the number of screening tests performed on blood and the restrictions on donors have grown. This week, blood labs will start using a new, experimental test to detect West Nile virus in donated blood. They already test for HIV, a form of leukemia, hepatitis B and C and syphilis. In addition, the list of questions about health, travel and sexual history that can disqualify donors has burgeoned to nearly 50, up from about 15 in the era before HIV.

The result of all the new restrictions, many of them imposed in the last year: Blood banks can't accept donations from people who lived in England for three months between 1980 and 1996 or in Europe for five years since 1980. You can't give blood if you had a fever with headache in the last week, or if you just returned from Toronto, Taiwan or any other place affected by SARS.

Dan Heffernan of San Francisco, a regular donor here at Blood Centers of the Pacific, says he doesn't mind being asked all those questions, but he wonders where it's heading. ''I've got a feeling that one day they're going to ask if you've ever been on an airplane.''

Blood is and must remain safe, blood bank directors say, but they worry that an excess of caution will create serious shortages.

''With every new question, every new test, we always end up deferring more donors,'' says Nora Hirschler, president of Blood Centers of the Pacific.

At a time when the blood supply is ''always on edge,'' every eligible donor is needed, says Mike Strong, vice president of the Puget Sound Blood Center in Seattle. ''They keep putting more and more hurdles in front of us, and unfortunately, many people don't want to give blood anyway.''

The economy is having an effect, too. ''People, when they lose their jobs, are not willing to help humanity. In Seattle, Boeing laid off 30,000-plus workers. That's had a huge impact on our blood drives. We're just having to work harder and harder to replace donors we're losing.''

The Food and Drug Administration regulates blood donations. It requires donor restrictions, which it calls ''deferrals,'' to reduce the risk that diseases might be passed from person to person by way of transfusion. Regulators are following the lessons of the 1980s, when the blood industry's failure to address the risk of AIDS resulted in 20,000 people becoming infected with HIV through transfusions.

Safe blood, but not enough of it

But blood center officials now worry about another danger: ''The concern we have is that we will have extremely safe blood but not enough blood,'' Hirschler says.

The most controversial of the FDA regulations are the ones aimed at reducing any possibility that blood could transmit the human form of mad cow disease, called variant Creutzfeldt-Jakob disease. There is no evidence the disease is transmitted through blood, yet because it is theoretically possible, the FDA last year enacted a list of restrictions that is dizzying: Donors are deferred if they lived in the United Kingdom for three months or more from 1980 to 1996; spent five years or more in Europe since 1980; spent six months or more from 1980 to 1990 on a U.S. military base in Belgium, the Netherlands, Germany, Spain, Portugal, Turkey, Italy or Greece or received a blood transfusion in the U.K. since 1980.

America's Blood Centers, an affiliation of independent blood centers that together provide half of the U.S. blood supply, said it expected to lose 300,000 units of blood from these restrictions alone.

The lengthening list of donor exclusions is ''the death of 1,000 cuts,'' says Louis Katz, medical director of the Mississippi Valley Regional Blood Center in Davenport, Iowa, and president of America's Blood Centers.

Each new restriction ''costs you some number'' of donors, he says. ''They add up.''

Jerry Squires, chief scientific officer of the American Red Cross Blood Services, which provides half of the nation's blood supply, says there are plenty of qualified donors, ''more potential donors than realized,'' but about 90% to 95% of those who could give don't.

Among reasons people say they don't give blood are inconvenience, fear, lack of time and ''just not knowing how critical it is,'' Squires says.

Americans answer the call

When there is a crisis, Americans roll up their sleeves, as they did on Sept. 11, 2001, when thousands lined up at blood banks across the country. There turned out to be little need for blood, though, so America's Blood Centers began asking donors to reschedule rather than risk collecting more than could be used within the 42-day shelf life for whole blood.

The American Red Cross, however, continued to collect blood and wound up dumping more than 45,000 pints, 5% of what was collected, because the blood became outdated. That infuriated some donors, blood bank officials say.

''Certainly, in some people's minds, that was troubling,'' Squires says, but ''I don't think that's had a long-term effect'' on donation rates. Routinely, he says, 2% to 3% of blood becomes outdated and is discarded.

But Lisa Bloch, communications director for the Blood Centers of the Pacific, says the publicity was ''tremendously detrimental to our relationship with future blood donors, and we are still trying to recover.''

Even though her center is not affiliated with the Red Cross, she says, the whole industry suffered. She says less than 1% of blood collected at Blood Centers of the Pacific is discarded.

Once blood is collected, it takes at least 48 hours for it to be tested, processed and made ready for transfusion.

''We're always playing a balancing act,'' she says, because in an emergency, it's ''the blood already on the shelves that saves lives.''

As in many urban areas, Bloch says, not enough blood is collected here locally to meet the 450 pints a day needed by the 40 Northern California hospitals these centers supply, so about 25% is shipped in from other parts of the country.

Even that has become more difficult, because it's no longer possible to import blood from Europe.

''The New York Blood Center used to get a third of its blood from Europe,'' she says. ''Now they have to go to the rest of the country to meet their needs.''

San Francisco Bay-area donors give about 375 pints each day, Bloch says, but keeping the rates up is a challenge. ''We turn away 100 donors a month'' solely because of the mad cow exclusions, she says.

Isadore Rosenthal of San Francisco, a retired civil servant who worked for the U.S. Army on military bases in Belgium, Germany and Italy for about seven years in the 1980s, has given more than 100 units of whole blood and 200 donations of platelets in the last several years.

But last year he was told he could no longer give because he might have been exposed to mad cow disease while in Europe.

He says the indefinite deferral is ''worse than disappointment, worse than frustration. It's a big letdown. I made a personal commitment that so long as I'm healthy, I'm going to donate blood.''

Advertising for donors

To help recruit new donors and keep the regulars coming back, Blood Centers of the Pacific, which has a dozen centers throughout the region, advertises and offers gifts -- T-shirts and raffle prizes -- along with the usual post-donation juice and cookies.

Those who give platelets or plasma, which are used to treat cancer and other serious health problems, get to recline in one of the center's new ''e-chairs,'' which offer Internet hookups for checking e-mail, and DVD screens overhead.

The process, called apheresis, takes about 90 minutes to draw blood, send it into a machine that separates it into its components and return what is not needed through a second tube. In some centers, both arms are needed for the process as blood leaves one arm and returns to the other, but here, only one arm is needed, which leaves the other free to click a mouse or make phone calls.

Heffernan, 58, a real estate investor and frequent apheresis donor, spends the time watching TV. He likes the e-chair, but it's not why he comes here every six weeks.

He does it ''because it's one of the things you can do, one of those lifesaving things,'' he says. Unlike writing a check to a charity, giving blood ''brings you closer to the feeling that you donated to someone. It's a much closer connection.''Cover storyCover story