Ongoing blood shortage takes toll on most at-risk patients

Blood shortage may delay college student’s treatments as she waits for transplant

Since the age of 6, Hagan Hill has needed blood donations to manage a rare liver disease. Across the nation, the pandemic has made it more difficult for patients like her to get the blood they desperately need.

The South Texas Blood & Tissue Center lost 1,000 blood drives, the equivalent of 7,600 blood donations, this year because of the COVID-19 pandemic. This fall, the community blood center continues to struggle to get the 500 donations it needs every day to meet the needs of patients in hospitals across the region.

That includes patients like 20-year-old Hagan, whose family hopes there will be enough blood when she is finally scheduled for a second liver transplant. Because the procedure involves transplanting a partial liver from a living donor, it was considered elective surgery and was delayed due to the coronavirus outbreak.

Jeanie Hill, Hagan’s mother, said that when the lifesaving procedure can finally be scheduled, it will not take place unless adequate amounts of blood are available.

“Think of it – it could be your loved one who may need a lifesaving liver, heart or kidney transplant – and you would want them to live,” she said. “So we are pleading with the community to please step forward, because you may need it yourself someday.”

Hagan has required blood transfusions since her diagnosis of autoimmune hepatitis and primary sclerosing cholangitis at the age of 6. She received a liver transplant at 14, after an episode of massive gastrointestinal bleeding, but her condition now requires another transplant.

She also suffers from severe anemia. The shortage of blood over the summer forced her to take an iron treatment instead of a blood transfusion, her mother said.

“We would have preferred Hagan to have received a blood transfusion vs. iron,” Jeanie said. “Blood obviously would work faster to raise her iron level, therefore she would receive the benefits quickly.”

The COVID-19 pandemic has affected blood donations not only in South Texas but across the nation, said Elizabeth Waltman, Chief Operating Officer of the South Texas Blood & Tissue Center, a subsidiary of San Antonio-based BioBridge Global.

“For most blood centers, blood drives produce about 70% of the donations in a typical year, and most of those drives were cancelled over the summer because of the pandemic,” she said. “Usually when there are shortages, community blood centers work together to fill the need, but in this case, the shortage is nation-wide and no one has blood to send.” 

Blood collections typically increase during the fall, because school-related drives normally provide up to a quarter of all donations. But because of the pandemic, universities and high schools are hosting very few blood drives, so thousands of additional blood donations are being lost, creating uncertainty for patients needing blood.

The center is asking the community to step up and donate blood during a time of critical need. It is also asking businesses and organizations to work with it to find new ways to host blood drives and encourage donation this fall, even if employees and students are still at home.

“For every patient who needs blood, it’s a 9-1-1 situation,” Waltman said. “We have had a lot of community support already, but the community needs more drives for the people who need blood in South Texas.”

In South Texas, donors wanting to give blood and organizations to sponsor a drive can contact the South Texas Blood & Tissue Center at 210-731-5590 or visit SouthTexasBlood.org/Give-Now. Donors also can give at University Hospital by calling 210-358-2812 or visiting DonateBloodToday.com. To sign up as an organ donor, visit DonateLifeTexas.org.

All donations are by appointment only to help maintain proper social distancing.

How can I find out my blood type?

Simple tests can reveal if you’re O-positive, AB-negative or something in between

If you’re curious about your blood type, there are several ways to discover it.

The easiest way is to donate blood with the South Texas Blood & Tissue Center. We’ll run tests to determine your type and put it on your donor profile.

Science of blood typing

The most common blood typing is the ABO and the Rh systems. They are determined by:

  • The presence or absence of type A or B antigens on your red blood cells. If you have type A antigens on your red cells, you have type A blood. Same goes for type B. If you have neither A nor B antigens on your red cells, you are type O. If you have both, you’re type AB.
  • The presence or absence of what is known as the Rh factor. If you have it, you are Rh positive. No Rh factor? Rh negative.
  • Your blood type is determined by your genetics – you get it from your parents. While the ABO system is most commonly used, there are hundreds of other types, some of them extremely rare.

The system for determining blood types has been around since 1900.

Figuring out your type

We run simple tests on your blood donation to determine its type:

  • A sample of your blood is mixed with antibodies that react to type A, and another is mixed with antibodies that react to type B.
  • We look at the samples after they spin around a centrifuge.
  • How the samples react to the antibodies – or if they react – determines your ABO type.
  • Another small sample is mixed with an anti-Rh serum, and if the cells clump together, you are Rh positive.

Scientists struggle to develop artificial blood

Despite 150 years of research, major roadblocks keep scientific ‘Holy Grail’ out of reach.

Scientists refer to artificial blood as the “Holy Grail” of trauma medicine. They have been trying to develop it for 150 years, and the history of that research is littered with failures.

That’s why you hear us say “there is no substitute for blood” at the South Texas Blood & Tissue Center. Right now, there isn’t one.

Narrowing the functions

Blood performs a wide range of functions in your body. That complexity makes it difficult to replicate in the laboratory, which is why efforts have focused on single functions like the delivery of oxygen and removal of carbon dioxide from cells.

In 2009, three researchers published an article, “A Review of Blood Substitutes: Examining The History, Clinical Trial Results, and Ethics of Hemoglobin-Based Oxygen Carriers,” that looked at the history of the issue.

The problem: The compound that carries oxygen and removes carbon dioxide is hemoglobin, which is carried within red blood cells.

By itself, hemoglobin can raise iron to toxic levels within the body and lead to organ damage, strokes and heart attacks. Multiple studies have not moved beyond the first stage of clinical trials because of the dangers.

Artificial blood has been seen as a solution to some of the issues related to transfusions, in both emergencies and as a long-term therapy. But the major issues remain to be overcome, as noted in an article from Stat News in 2017.

“The quest to develop substitute blood has bedeviled researchers in academia, the military, and the biopharma industry, with several companies abandoning their attempts,” he article said.

“The quest for the Holy Grail of blood substitutes remains unfulfilled,” the authors of “A Review of Blood Substitutes,” wrote. “However, if such a product can be developed, it will dramatically change both surgical and critical care medicine.”

You can have your ink/piercing and give blood, too

Tattoos, piercings can’t keep you from saving a life with a blood donation

One of the biggest misconceptions about giving blood with the South Texas Blood & Tissue Center is that a tattoo or piercing disqualifies you from donating.

Guidelines

With just a few exceptions, that isn’t the case. You can have recent ink or piercing and be a blood donor right away if done under this guidance:

  1. Your tattoo has to be done in a state-regulated facility
  2. The artist must use sterile needles
  3. The ink must be one-time-use only
  4. The tattoo must be completely healed. This means no signs of peeling, no scabbing or itching and the tattoo no longer needs to be treated with ointment.
  5. If you have a tattoo in the area where the needle for a blood donation goes (in the inside of your elbow), you will need to give your tech permission to insert it.

Unregulated shops

Tattoo shops are regulated in all but 10 states and the District of Columbia. But under new FDA changes this year, you only have to wait three months instead of twelve to give blood after getting inked in:

  • Georgia
  • Idaho
  • Maryland
  • Massachusetts
  • Nevada
  • New Hampshire
  • New York
  • Pennsylvania
  • Utah
  • Wyoming
  • District of Columbia
  • State-regulated tattoo facilities are required to pass certain safety and health standards to avoid contaminating blood with bloodborne conditions, mainly hepatitis.

Piercings

Similar guidelines apply for piercings. You can donate blood right away if they are completely healed and done in a state-regulated facility with single-use equipment. You’ll have to wait three months if they were not.

What medications can I take if I want to give blood?

For the most part, taking over-the-counter and prescription medications will not prevent you from giving blood at the South Texas Blood & Tissue Center.

Below are some examples and answers to common questions.

Pain relievers and common prescriptions: Yes

As far as OTC pain relievers like Aleve, Advil or Tylenol go, you can give blood without any problems after taking them. Same goes with prescriptions for conditions like type 2 diabetes and asthma.

You can give whole blood if you take aspirin, but not platelets because aspirin affects the way they function. You won’t be able to give platelets right away if you’re taking drugs like Feldene or Plavix to prevent a stroke or heart attack.

Click here to see a full list of medications that may affect your ability to give a whole blood donation.

Antibiotics: Yes and no

There’s one large group of prescription drugs that can prevent you from donating: antibiotics. We don’t want to take a donation from you if you have circulating bacteria in your system.

However, you can give blood seven days after finishing your last dose of an antibiotic for an infection, and if you are taking antibiotics for preventive reasons – like acne – you still can donate.

No ‘blood thinners’

If you have been prescribed “blood thinners” to prevent blood clots and strokes, you may not be able to donate because of the risk of excess bruising or bleeding.

Click here to see a full list of medications that may affect your ability to give a platelet donation.

Other medications: It depends

Prescription acne medications like Accutane and hair-loss prescriptions like Propecia have been shown to cause birth defects, so your last dose will need to be a month before your blood donation.

Some cancer treatments, including drugs for multiple myeloma and basal cell skin cancer, and immunosuppressants like Cellicept also can cause birth defects if your blood is transfused to a pregnant woman.

Fortunately, if you have finished taking most of the prescriptions on our Medical Deferral List, you will be able to donate after a waiting period, ranging from a few days to three years.

Some are ‘always no’

There are a few drugs that permanently prevent you from giving blood. If you ever took the drug Tegison (prescribed for psoriasis), human growth hormone made from human pituitary glands, or insulin from cows manufactured in the United Kingdom, we can’t take your donation.

Feel free to contact our Donor Eligibility line, 210-731-5555, extension 2243, or send an email to DonorEligibility@SouthTexasBlood.org if you have any questions.

‘Old’ science leads in fight against COVID-19

Convalescent plasma, first discovered in the 19th century, authorized for use in fight against coronavirus

A doctor’s reaction to a potential epidemic almost 90 years ago forms the basis for one of the few therapies for patients with COVID-19 today. That therapy was in the news recently, as the FDA issued an emergency use authorization for it on Sunday, Aug. 23, with the goal of making it more widely available.

Back in 1934, Dr. J. Roswell Gallagher, staff physician at a boys’ school near Philadelphia, knew he had to act fast when one boy came down with the measles, then gave it to two others in the school’s infirmary.

So he looked back to science from the turn of the 20th century. Research showed that “antiserum” – plasma, the liquid part in the bloodstream – could be used to prevent or treat diseases.

Gallagher collected and purified plasma from the first boy to recover from the measles and gave it to 62 other students.

Three developed mild symptoms. No one else got sick.

‘Antiserum’ therapy makes a comeback

As patients began suffering from COVID-19 earlier this year, Dr. Arturo Casadevall, chair of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health, remembered the lessons Gallagher had practiced decades ago.

Casadevall proposed bringing back “antiserum” – now known as convalescent plasma – as a treatment in an op-ed article in the Wall Street Journal in late February.

As reported on the Johns Hopkins University site The Hub, Casadevall’s idea spread quickly.

Teams were assembled, protocols were defined and groundwork was laid for a clinical trial using convalescent plasma to fight COVID-19, including the clinical trial being run by the Mayo Clinic, of which the South Texas Blood & Tissue Center is a part.

Warp speed deployment, results

A clinical trial at Methodist Hospital in Houston was established for the use of convalescent plasma on March 24. Less than a week later, the first patients received it.

The first dose was collected at the South Texas Blood & Tissue Center in early April and quickly transfused to a seriously ill patient— who has since recovered and now is eligible to donate himself.

Nationally, tens of thousands of patients have received convalescent plasma. A preliminary look at patient data by the Mayo Clinic showed a 50 percent decrease in mortality rates in patients receiving the transfusions, especially if they receive plasma soon after a positive test.

The Collective Grief of COVID-19

Grappling with any kind of loss involves a grief process, even if the loss isn’t tangible.

We are all dealing with non-tangible losses during this COVID-19 pandemic such as:

  • Physical connections
  • “Old normal” or ”remember when” routines
  • Our safety and certainty about the future
  • Dread that there are more losses to come (anticipatory grief – dreading something bad will happen, but being unable to see it).
  • Grief is messy! We need to embrace the mess and honor the struggle we’re going through.

You might be experiencing stages of grief dealing with the COVID-19 pandemic:

  • Denial – I can’t believe this is still going on
  • Anger – I’m so mad that… (examples: my kids can’t go to school, I can’t see my loved ones/friends in person, why aren’t others doing what they should be doing)
  • Bargaining – If/then… (example: if I wear a mask, then I can see my friends)
  • Depression – The world as we knew it at the beginning of 2020 is gone (and who knows what is yet to come)
  • Acceptance – COVID-19 is still here and not going away soon. What can I do to live productively in it?
  • Find/make meaning out of the losses – work in progress
  • Grief brings baggage from previous losses.

Strive to find balance in what you’re thinking about.

Try to stay in the “now” and let go of what you can’t control.

Practice self-compassion. Name your feelings (emotions need motion).

Self-care tips:

  • Breathe – Inhale smelling your favorite flower. Exhale like you’re blowing out birthday cake candles
  • Drink water
  • Get up and move (stretch, play…)
  • Look for small wins, 3 good things every day
  • Limit your intake of news

Donor highlight: William Berlin

My son, William Berlin, was born on September 15, 1995. He loved spending time with his family and friends. I have so many memories of him making people laugh. Once, I told him to audition for the character position at Six Flags Fiesta Texas. I did not know he was actually auditioning for a dance position. When I heard the music, I thought to myself, “He has to dance! I think I made a mistake.” I just cracked up laughing.

He came out from the audition, all sweaty, and said “Mom, what did you do to me?” William didn’t get that position, but he did get the character that stands to take pictures with the kids. After his audition, we both went to the car and laughed about the whole thing.

My son always wanted to give. He was little when he asked me what an organ donor was. When I told him, he said that he would be an organ donor when he grew up. When I started having trouble with my liver, William said he would donate half of his for me. I had to tell him he couldn’t donate just yet.

William always wanted to donate blood, too. When he was 15, he was so disappointed that he could not donate blood yet. When he turned 16 and got his driver’s license, he signed up to donate his organs. At 17, he begged me to donate blood and brought home a permission slip. Ever since that day, he would donate his blood any chance he could get.  

On November 16, 2017 he was hit by a truck. He fought to stay alive for 2 weeks. He passed away at the age of 22 and was able to help other people by donating his organs. He was able to donate his kidneys, corneas, and tissue.

It has been two and a half years since my son passed away, and I am still trying to process his death. Our experience with William’s donation process was surreal. Everything happened so fast. They kept him alive until all the paperwork and staff were ready for him.  During that process, our family was able to say our last goodbyes. 

We are proud, honored, and sad that he was able to do what he always wanted to do.

For more information about blood and tissue donation, please click here.

Setting a goal: Make 24 donations in a year

BioBridge Global employee Ken Doyle continues family legacy

Last year, Ken Doyle gave blood 10 times. This year’s goal is substantially higher: 24 platelets donations.

“My mother and father used to donate, and I think it is nice to continue that legacy,” said Doyle, an Instructional Designer with BioBridge Global Human Resources and Learning. “I don’t personally know of anyone that needs a blood donation, but I know of people’s needs, so I donate on behalf of those in my heart and in my memories.”

Pandemic motivations

With the COVID-19 pandemic, blood supplies have been tested across the country. In some places, one- to two-week blood inventories quickly dropped to one-to two-day inventories during the early days of the outbreak. Those shortages just make Doyle want to keep donating.

Like all donors, he schedules his donations in advance and fills out a pre-donation health questionnaire electronically the day of his donation to save time. Platelets are replenished within seven to eight days, so he can schedule a donation every two weeks.

“If I stick to it, then there will be a lot of people who will benefit from it, and the positive will be that 24 people could live a little longer or could be healed,” he said.

Quick distribution of a lifesaving donation

Elizabeth Waltman, Chief Operating Officer at South Texas Blood & Tissue Center, said Doyle is one of the organization’s best platelet donors.

“Ken is actually going to be helping someone in less than 48 hours whose platelets will be at some hospital ready to be transfused into a patient and help them save their lives,” she said.

To schedule a blood donation, please 210-731-5590 or visit SouthTexasBlood.org.

The story was prepared by students at Our Lady of the Lake University as part of a service-learning course.