Nation's blood supply failing to meet demand

Fears emerge that new restrictions on blood donors will add to a year of national shortages.

By Susan J. Landers, amednews staff. Aug. 20, 2001.

Washington -- Campaigns for blood donations are likely to become more vigorous in the near future as blood supplies dip, demand grows and new restrictions on who can donate come into play.

Blood supplies have been generally low this year, and some areas have experienced critical shortages. "Many of us believe we're on the brink of a crisis," said Harvey Klein, MD, president of the American Assn. of Blood Banks.

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"For the first time in memory, we've had a year of national shortages, not just regional shortages and not just shortages at what are generally considered to be the time periods when blood is always in short supply," he said.

The American Red Cross sees blood shortages as cyclical events that have occurred regularly during the last 50 years. But the organization, the nation's prime supplier of blood, has had enough of that. "One of the safety issues out there right now is the availability of blood," said Jerry Squires, MD, chief scientific officer for the Red Cross. "Not only does the individual unit have to be as safe as it can be, but there have to be enough of them to treat all the patients who need them."

The margin between the supply of donated blood and the demand for blood for transfusions shrank substantially over the last decade, according to a report by the National Blood Data Resource Center, an independent organization founded by the American Assn. of Blood Banks.

Given the tenuous balance between donations and need, new restrictions on who may donate blood are being viewed with dismay by many.

On Sept. 17, the American Red Cross will begin turning away potential donors who have lived six months or more in Europe between 1980 and the present and donors who lived for three months in the United Kingdom during that same time period.

The restrictions were developed as a preemptive strike to keep mad cow disease, or bovine spongiform encephalopathy and its human form, variant Creutzfeldt-Jakob disease, from infiltrating the U.S. blood supply.

An advisory committee of the Food and Drug Administration has also recommended curbs on donations from those who lived in countries afflicted by BSE, but the curbs were not quite as stringent as those adopted by the Red Cross.

These restrictions are viewed as overly cautious by many since there is no evidence that the deadly brain disease is spread via blood. But the Red Cross decided to err on the side of caution. Citing laboratory studies in animals, which gave some indication that mad cow disease could be transmitted by blood, "we felt it was better to take the more conservative approach, because we can't fix a case of mad cow disease if it really is transmitted by transfusion," Dr. Squires said.

Trouble for the Big Apple

The New York City area will be particularly hard hit by the restrictions because the region receives 25% of its donated blood from an arrangement with European countries, said Doris Varlese, associate general counsel for the Greater New York Hospital Assn.

The large New York medical centers perform a huge number of surgeries and historically have not been able to meet their need from local donations, said Varlese.

New York is not the only large metropolitan area that will be affected by the new restrictions, said Melissa McMillan, spokeswoman for America's Blood Centers, a national network of blood centers that collect almost half of the nation's blood supply.

All cities with large academic and medical centers will likely be affected, she said.

New York is working with the federal government on a stopgap plan to allow blood collected from U.S. soldiers stationed in Europe to be shipped to the city.

That plan is in its earliest stages, said McMillan.

Adding to the woes of hospitals nationwide are price increases of about $50 per unit of blood that were recently instituted by the Red Cross. Dr. Squires acknowledged that the price increase is steep, but noted that it comes after many years in which increases had been deferred.

Part of the increase pays for the cost of filtering white blood cells from all the blood distributed by the Red Cross.

The organization had previously offered both filtered and unfiltered blood, but, for safety reasons, now offers only filtered blood, said Dr. Squires. "Leukoreduction undoubtedly reduces the incidents of transfusion reactions, it undoubtedly minimizes the risk of certain viral infections, and there is evidence that ... [it] reduces the incidence of post-operative infections in transfused patients."

The AMA and many other medical groups object to universal leukoreduction because all patients do not require filtered blood and they fear doing so will exacerbate existing shortages.

The AMA recently signed on to a letter spearheaded by the College of American Pathologists to Health and Human Services Secretary Tommy Thompson urging him not to implement a universal leukoreduction policy recommended by an FDA advisory panel until there is a consensus backed by scientific evidence that such a policy is needed.

Meanwhile, there are many other factors that come into play regarding the nation's dwindling blood supply. The population that traditionally donated blood, the so-called World War II generation, is aging, noted Dr. Klein, and is more likely to require transfusions than to donate.

Workplaces are also downsizing and putting a push on individual productivity. Large factories that had welcomed blood drives are closing or moving abroad, said Dr. Klein. And in the competitive climate of today's business world, workers may not be allowed much time away from their desks to attend blood drives.

Recruitment may be difficult for another reason: "We are increasingly finding out on surveys that maybe 40% of the eligible population say they are unwilling to donate," said Dr. Klein. "We need to find out why that is and see whether or not we can convince some of those people who are eligible that donation is important, just as we are convincing people that organ donation is important," he said.

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Blood products to the rescue?

With predictions of a persistent national blood shortage looming, now would be a good time to unveil an artificial blood product that could take the strain off the nation's supply of the real thing. But that's not likely to happen for awhile.

Although three private firms have products in late-stage clinical trials, it may be a few years at best before one is available for use, said George Nemo, PhD, scientific group leader in transfusion medicine at the National Heart, Lung and Blood Institute.

Work on blood products has been going on for many years, and firms have invested hundreds of millions of dollars into the development of oxygen-carrying substitutes for red blood cells.

Because private firms keep their data to themselves, it's difficult to evaluate progress. But Dr. Nemo views it as promising that the Food and Drug Administration has allowed them to proceed to trials that involve patients.

While even the best products won't replace blood, they could be appropriate in certain situations, said Joel Friedman, MD, PhD, head of the Albert Einstein Blood Substitute Program in New York.

"The main objective now is to have something that can be used in situations where there is a big loss and you need to replace blood quickly and not worry about the source," he said.

The substitutes have a short life -- 18 to 48 hours -- as compared to normal red blood cells that circulate in the body for about 120 days.

"It's something to tide you over for one or two days," said Dr. Friedman. "But there's a big need for that."

Another thing to remember is that the products in development are only oxygen carriers.

"Nobody has any artificial platelets or plasma or anything to help the blood clot," noted Jerry Squires, MD, chief scientific officer for the American Red Cross. "There has to be regular blood down the road."