Aggiornato il: giu 22
By Chiara Cutaia
Translated by: Roberta Novelli
In 2004, the WHO established the "World Blood Donor Day" (WBDD).
The date chosen is not random and occurs on the 14th of June, the birthday anniversary of Karl Landsteiner, an American biologist, who was awarded a Nobel Prize in 1930 for discovering the presence of different blood groups.
The donation of blood is an act of solidarity that every day allows to save many lives. Often due to organic causes (such as anemia) or external causes (such as surgery) the hospitalized patient has to be subjected to a blood transfusion; It is therefore important that each of us make our own contribution by giving so that there is always availability for the less fortunate and to preserve them from the inauspicious consequences.
FOR WHICH INDIVIDUALS IS IT USEFUL TO DONATE?
As mentioned above, there are pathological situations where the administration of blood is an indispensable and necessary therapeutic act:
1. surgery, organ and bone marrow transplants;
2. for patients with oncological and haematological diseases (e.g., leukemia, lymphomas);
3. in case of a chronic anemia (clinical condition that occurs when hemoglobin falls below 7-8 g/dl due not to acute events such as a haemorrhage but to a chronic disease such as inflammatory bowel disease), immunodeficiencies (when the immune system is not able to play its full role), haemophilia (pathology that causes a blood clotting defect).
Blood may be given in various forms and in particular:
· red blood cells for the treatment of different types of anemia;
· platelets for various haemorrhagic diseases (such as haemophilia);
· plasma used in case of liver burns or tumors;
· plasma derivatives such as albumin, used in the treatment of certain diseases of the liver.
WHO CAN DONATE?
Our Ministry of Health has provided guidelines to indicate "ideal" donors (D.M 2/11/2015), who must meet specific requirements, which are evaluated by the doctor on duty in the transfusion reference center.
• 18 to 65 years of age (sometimes up to 70 years of age, with the examining doctor’s agreement );
• minimum body weight of 50 Kg;
• good general health status;
• a systolic pressure not exceeding 180 mmHg and a diastolic pressure not exceeding 100 mmHg;
• a regular heart rate (between 50 and 100 beats/minute);
• Standard Haemoglobin values (equal to or greater than 13,5 g/dl in men and 12,5g/dl in women).
In addition, a thorough history (collection of clinical/health informations from the donor) will be performed.
In addition to a careful medical history and an objective physical examination, before being able to donate the donor is subjected to a complete blood test to avoid risks to his health and the recipient’s health and in particular:
1. test for HBsAg antibodies (hepatitis B);
2. test for anti-HCV antibodies (hepatitis C);
3. test for HIV antibodies;
4. ABO phenotype by direct and indirect testing (necessary to understand the blood type of the donor that must be compatible with the recipient);
5. Rh phenotype (also this phenotype must be compatible with the one of the recipient);
6. creatinine concentration (a renal function index);
7. glycemia (blood sugar levels);
8. serum protein (evaluate the proteins in the blood);
9. serum protein electrophoresis (evaluates the quality of proteins in the blood);
10. Complete blood count (CBC) (evaluates the presence of different parameters such as: amount of white blood cells, red blood cells and platelets);
11. Total iron binding capacity (TIBC) (evaluates the amount of iron present in the body);
12. Alanine Aminotransferase Test (ALT) (evaluates liver function);
14. triglycerides test;
All these assessments are very important in ensuring high standards of safety and vigilance.
As I have just described, there are many standards to be met to be qualified as "ideal" donors, let’s have a look at the main criteria for exclusion from donation
Permanent exclusion criteria to protect the donor’s health:
• previous malignant and haematological neoplasia;
• people with coeliac disease who do not follow a gluten-free diet;
• cardiovascular diseases;
• people suffering from arterial hypertension and who do not follow an adequate pharmacological control or with organ damage;
• organic diseases of the central nervous system;
• people who have received a previous transplant;
• people with history of epilepsy;
• people with gastrointestinal, hepatic, urogenital, haematological, immunological, renal, metabolic or respiratory diseases if present in an active, chronic, relapsing form or having permanent organ damage caused by the indicated conditions;
• people with diabetes in treatment with insulin.
Permanent exclusion criteria to protect the recipient’s health:
• infectious diseases: hepatitis B, hepatitis C, HIV infection, syphilis;
• previous transplantation of cornea, sclera or dura mater;
• people with family or personal history of: fast progression dementia, degenerative neurological diseases;
• people who stayed for more than 6 cumulative months in the United Kingdom during the time frame from 1980 to 1996;
• people who underwent surgery or blood transfusion or administration of blood products in the United Kingdom from 1980 to 1996;
• except people with current or previous non-prescription use of pharmacological substances or active ingredients, including narcotic drugs, steroids or hormones for sports purposes, intramuscular (IM), intravenous (IV);
• people whose usual and recurrent sexual behavior is characterized by: promiscuity, casual sexual intercourse, sexual intercourse with exchange of money or drugs;
• chronic alcoholism.
Temporary exclusion criteria:
• Acute Glomerulonephritis (inflammatory kidney disease): at least 5 years after full recovery;
• Brucellosis (an infectious disease): at least 2 years after full recovery;
• Osteomyelitis (bone infection): at least 2 years after full recovery;
• Tuberculosis: at least 2 years after full recovery;
• Rheumatic fever (systemic inflammatory disease): at least 2 years after cessation of symptoms in the absence of chronic heart disease;
• Lyme disease (tick-borne illness): at least 12 months after healing;
• Toxoplasmosis: at least 6 months after full recovery;
• Mono (infectious mononucleosis): at least 6 months after full recovery;
• Fever > 38°C (100.4°F): at least 2 weeks after cessation of symptoms;
• Flu: at least 2 weeks after cessation of symptoms;
• Malaria: people who have lived for a period of 6 months or more (ongoing) in the endemic area at any point in their life span must be suspended from donations for at least 6 months from the last stay of any duration in an endemic area for malaria;
• people having performed an endoscopic examination with flexible instruments: at least 4 months after the last exposure to the risk condition;
• mucosal contamination with blood or needle injuries: at least 4 months after the last exposure to the risk condition;
• tattoos or piercings: at least 4 months after the last exposure to the risk condition;
• acupuncture, if not performed by qualified professionals with disposable needle: 4 months from the last exposure to the risk condition;
• risky sexual behavior: at least 4 months after the last exposure to one or more of the risk conditions, represented by heterosexual/homosexual/bisexual relationships with partners tested positive for hepatitis B and/or C and/or HIV or at risk of being so, with partners who have had a history of sexual behavior at risk or of which the donor ignores sexual habits, with occasional partners or with multiple sexual partners, with drug addiction, with exchange of money and drugs;
• major surgery: at least 4 months in conditions of full health recovery;
• minor surgery: at least 1 week after full clinical recovery;
• during pregnancy or at least 6 months after childbirth or interruption of pregnancy;
• dental care: at least 48 hours for minor dental care by dentists or dental hygienists;
• Postpone in case of medication consumption for a variable period of time according to the active ingredient of the prescribed medication;
WHAT THE DONATION CONSIST OF?
The whole blood donation procedure takes an average of 15 minutes, while plasma can take up to 30 to 60 minutes.
According to the guidelines of the Ministry of Health, 450 mL of blood is taken. Before donation it is not necessary to fast, it is necessary to make a light breakfast. Upon arrival you must fill in an informed consent to the donation and a donor registration form. Afterward there will be an interview with the doctor, who will judge the suitability of the donor. It will be, then, a nurse to make the withdrawal, after having the donor lying on a bed and performed the disinfection of the skin. The needle used is sterile and disposable; it is inserted into a vein, usually of the non-dominant arm. The blood will drain into a collection bag, which contains anticoagulant fluids and preservatives, located below the donor. Before removing the needle the nurse will fill some tubes to carry out the examinations required by law (as explained above). It is a controlled and safe procedure, there is no risk of contracting an infectious disease.
After the withdrawal a breakfast is generally offered to replenish the lost liquids and ensure better comfort; it is recommended to drink a lot of water, eat regularly and do not perform tiring and/or risky activities during the following hours. In case of blood or blood products donation, the worker is entitled to a paid rest day, as it is possible to receive a justification sheet.
In conclusion, we invite you to donate and leave you with a quote from Dr Margaret Chan, director of WHO from 2007 to 2017:
“Voluntary, unpaid blood donation is the act of giving life – the greatest gift any person can give or receive.”