A Mayo Clinic podcast for laboratory professionals, physicians, and students, hosted by Justin Kreuter, M.D., assistant professor of laboratory medicine and pathology at Mayo Clinic, featuring educational topics and insightful takeaways to apply in your practice.
This is Lab Medicine Rounds, a curated podcast for physicians, laboratory professionals, and students. I'm your host, Justin Kreuter, a transfusion medicine pathologist and assistant professor of laboratory medicine and pathology at Mayo Clinic. Today, to start off the new year, we're rounding with Dr. Kristen Ruby. She is also an assistant professor of laboratory medicine and pathology here at Mayo Clinic, and she is also the medical director of our Mayo Clinic blood donor program to talk with us about National Blood Donors Month and the impact that blood donors make.
Dr. Kreuter:Thanks for joining us today, Dr. Ruby.
Dr. Ruby:Thank you. It's a pleasure to be here.
Dr. Kreuter:So this first question maybe is a little bit of an odd one, but I always like to start off with the why question. So why should we be celebrating blood donors?
Dr. Ruby:So I think blood donors are so important. We really could not provide the type of medical care we do today without them. And that's because blood donors are literally giving a piece of themselves to help someone in need. They give their blood or portions of their blood. And for those of you listening who aren't aware, blood is a special type of fluid connective tissue that consists of cells.
Dr. Ruby:So it consists of red blood cells, which are the cells that carry oxygen. We've got white blood cells that fight infections and platelets, which helps stop bleeding. So the cellular part of blood, but also a fluid part of blood called plasma, which has nutrients, hormones, and proteins such as antibodies. So blood is a really complex tissue, and because of that, we actually don't have a good synthetic or artificial alternative. So, you know, we could try to just replicate, like, one portion of blood such as red cells, but even red blood cells alone are incredibly complicated.
Dr. Ruby:There are over 600 known antigens on red cells and over 40 different recognized blood group systems, which is why there's so much variation between blood people and why we really need a diverse blood supply. There are some clinical trials underway at attempts to try to grow red blood cells in the laboratory. But right now, there still is no truly safe or effective product on the market at this time. So currently, if a patient needs blood, the only way we can get it is by collecting it from another human. So getting back to your question, why blood donors should be celebrated?
Dr. Ruby:It's really because they offer something that is critical for sick patients. It's critical for surgical procedures requiring blood, and it's life saving for many, many people. And we have no alternative, so we can't get it anywhere else. So we rely on voluntary blood donors doing this out of the goodness of their heart to help people in need. And that's why it's so special, and we really need to celebrate this group of dedicated people.
Dr. Kreuter:Wow. I really appreciate you kinda kicking us off with this. I mean, it really sounds like blood donors are really the ultimate enablers. In other words, we can have all the fancy equipment or resources, but if there is not somebody that is willing to come in and spend a little bit of their time and donate their blood, that kinda makes all the fancy equipment and technology the moot point.
Dr. Ruby:Exactly. Blood is a major part of health care. It's a procedure that we do every day. Surgeons require it. And not just surgical procedures.
Dr. Ruby:People in the hospital who are anemic just require it as well to get, you know, oxygen delivery to their tissues so they can keep healing.
Dr. Kreuter:Right. So all these different diverse patient populations, diverse clinical situations are needing people to come in and donate their blood. So I'm on board. Definitely, we need to celebrate this group. What do we know about blood donors, as a group?
Dr. Ruby:I kind of like to think of blood donors in 2 groups, and I think of it almost from a procedural perspective in terms of the donation process. So I like to think of those who donate whole blood and those who donate a portion of their blood via apheresis. So whole blood donation is what I think most people think of when it comes to blood donation. They'll come in. They'll go through a questionnaire.
Dr. Ruby:So let's talk about the process, I guess. So in the United States, there's a few minimum requirements for being a blood donor because this is a process in the US that's regulated by the Food and Drug Administration, the FDA. So because of that, we have some minimum requirements such as being a £110. The reason for that is we don't wanna take too much of your blood. It's all related to the blood the average blood volume for someone of that weight.
Dr. Ruby:We don't wanna do anything harmful to these healthy people. So we've got a 110 pound requirement. In most states, you need to be at least age 16 or 17 with parental consent. Otherwise, age 18 and older, but most blood centers have no upper age limit. So anybody pretty much can donate if you're an adult.
Dr. Ruby:And then you have to pass a little physical, which usually includes a finger prick to make sure your hemoglobin is high enough and, mini questionnaire. Once you get through that, then you get to the actual blood donation part. So for going back to kind of that separated group, I we've got the process for whole blood donation where a needle goes into the arm, your whole blood comes out and goes into a bag. That's a whole blood donation. And once that goes to the lab, it can then be separated into its different components, such as red blood cells or platelets or plasma.
Dr. Ruby:The other process is once you're in that chair ready to donate blood, your blood could go out and instead of directly into a bag, it can actually go into a machine called an apheresis machine. And what that machine does is it centrifuges. It spins the blood. And when you're doing that, you can separate it out into its different layers. So your red blood cell layer, your buffy coat layer, which has the platelets and the white blood cells, and then your plasma layer.
Dr. Ruby:We could take off just the plasma or just the platelets and put that into a bag. And then everything else can go back to that blood donor. And that's a way that you can give just a portion of your blood. I like to think of blood donors as those 2 kind of groups, a whole blood donor or an apheresis donor. And it's interesting to think about it that way because there's different frequencies at which you can donate.
Dr. Ruby:So if you're a whole blood donor, you can come back to us every 8 weeks, generally at most blood centers, that's the rule, which is up to 6 times a year. And for platelet donors, it's every 7 days at most places, which is up to 24 times a year. So you can see that, you know, you can donate multiple times a year, not just one time a year. So I think that's what I know about blood donors from the collection perspective. There's a lot of other things we know about blood donors, such as the blood types, like the 4 main blood types.
Dr. Ruby:I think most people think of blood group a, blood group b, a, b, and o. And what that is referring to is the type of antigens that we have on our red blood cells. So, for example, group a donors have a antigen on their red blood cells. Group b donors have b antigen on their red blood cells. Group a b has both a and b, and group o has neither a or b on their red blood cells.
Dr. Ruby:And that's important because in the United States, the majority of blood donors are group o blood type, and then the next most common is a followed by b and and group AB. And that may not be the same in every country, but in the United States, that's what it is here. So that's important when we're figuring out which blood a patient needs. We need to make sure we have a a mix of those different blood types so that we have everything we need for the patients in the hospital. In the United States, I'd say there's about 6,800,000 people in the United States that donate blood, which is it's coming out to about 13,000,000 units of blood every year.
Dr. Ruby:So that is a lot of blood. And here in Olmsted County in Minnesota, there's someone who needs a blood transfusion about every 10 minutes. But across the United States where there's bigger cities, the need is even greater. And a blood product is needed about every 2 seconds. So there's a constant need for blood across the United States, not just here, but across the world as well.
Dr. Ruby:And we need blood donors continuously. Once you donate blood, there is a limit to how long that blood is good for depending on the different preservatives used. So most red blood cells are good for just over a month at 42 days, and platelets are just good for about 5 days. So we need people coming in all the time to donate to replenish the supply so that we never run out for the people who do need it. For more laboratory education, including a listing of conferences, webinars, and on demand content, visit mayocliniclabs.comforward/education.
Dr. Kreuter:So as you kind of went through there in talking about the process about how some ways we can think about the blood donors as a group, I'm I'm really very much respecting just how many people we need to have come in to support our communities, because certainly any one of us may end up in the emergency room later today. And it's the blood that was donated yesterday that's gonna be helping me out tonight, presumably. So these people are really important. Do you ever hear stuff like people are like, I'm not a group o donor. Right?
Dr. Kreuter:I think a lot of times people are used to hearing, like, the call for o negative donors or o positive donors, and maybe somebody's out there that's like, maybe they're group AB, and so they're like, man, I'm not valuable as a donor. I mean, is there some kind of a, like, a hierarchy for ABO types?
Dr. Ruby:Every donor is valuable. Let me put it that way, because every donation can be turned into many different blood products. So although AB blood may not be as compatible for every patient for red blood cells, their plasma is like gold. Their plasma can be given to pretty much any patient. So there's a role for every donor, and every unit of blood is unique just like every person.
Dr. Ruby:There's a lot of testing that we do on units once they get to the laboratory to determine which antigens they express. And we haven't really talked about this yet, but sometimes when a person is exposed to someone else's blood, a response can be to create antibodies against anything they see as foreign. And because of that, not only do you have to match the blood for something that's compatible, but you may need to avoid certain antigens to make sure that they're not going to destroy the blood that you give. So there's a lot of testing that happens to make sure a unit is compatible just beyond the ABO blood type. And because of that, every single unit is valuable.
Dr. Kreuter:Wow. So you just kinda knocked me to the curve there with, like, is there a hierarchy for ABO? Right? It sounds like we need all of the blood types to donate. And what you're highlighting there about the diversity is really important.
Dr. Kreuter:What do we know about the diversity of the blood inventory?
Dr. Ruby:Well, we try to make it as diverse as possible, which is why we really want a lot of different people to donate because the variety of people that we have that are sick that need blood is diverse. So for example, there's a lot of sickle cell patients or thalassemia patients that may need blood on a routine basis. And a lot of the blood donors out here in the United States may be Caucasian and they may not have the same antigen profile that's compatible. So we need people from all sorts of communities, every community to donate, to ensure that we have come out compatible blood for every patient that's out there.
Dr. Kreuter:Wow. So highlighting the fact that if we're talking about taking care of patients that are diverse, it requires a diverse blood supply. So, yes, we need all of the blood donors. People who are willing to come in and donate, need them to come in. So we can also celebrate them as blood donors, but also highlights the diversity in that group too.
Dr. Kreuter:So I like that, because I think there's a little bit of a, well, I somebody else is gonna answer the call. I think especially those of us in the community that represent ethnic minorities, you know, to understand that the blood that you're donating may be very significant in helping care for a patient from your same ethnic group.
Dr. Ruby:Exactly. And there are times when a blood that is compatible is is very difficult to find, and we may need to do minority ethnic group can be incredibly valuable because then that blip will be closer to home for someone, and we won't necessarily have to search quite as far and wide to find something that will really save their life.
Dr. Kreuter:As we're talking here, I'm thinking about how we're celebrating those who have donated blood. And one of the challenges is just the the confidentiality, right, that we always have to respect. And so I think blood donors may have the experience of coming in and answering all those questions all over again every time for that blood donor questionnaire because that's what's required and to donate their blood, but then they don't necessarily hear what their donation enabled. Can you share a story? Again, this is anonymous, not something that's happening today, but maybe in your past, a patient that you've been involved with where blood products made a significant difference, and maybe we can kinda use that as a fill in story.
Dr. Kreuter:People can understand that the blood that's being donated, this is the kind of stuff that we're talking about.
Dr. Ruby:Yeah. I can even just share my own family experience. Hemophilia runs in my family. And growing up, my mom's brothers had hemophilia, and there was no synthetic alternative at the time. So the only way they could get replacement factor 8, which is a coagulation factor, it stops bleeding, was through plasma donations.
Dr. Ruby:And so they were able to live many more years than they would have otherwise because of donations from other people. So that's just a plasma example. Another example is gallbladder surgery. My mom underwent it. It's a very routine procedure.
Dr. Ruby:Sometimes complications happen, and unfortunately for her, that was one case where there was a bleed found afterwards. She became hypotensive, was not doing so well, and they realized that she was bleeding, and they ended up having to give her 8 units of red blood cells in order to stabilize her to go back to surgery and and fix what happened. So for her, that blood saved her life. It made a difference. It gave her some time to stabilize.
Dr. Ruby:But these are just examples from my family. I mean, throughout my practice, I've seen emergency cases, people coming in from car crashes where we've given over a 100 red blood cells, you know, in the emergency department, in the operating room, and not just red blood cells, but also plasma, platelets, cryo, like, every blood product that we could give to help stabilize these people. And without that, these people would have died. So it is a necessary critical part. And without it, we could not do the types of procedures that we do to save people in these emergency type situations.
Dr. Kreuter:And we really appreciate the diverse situations you just shared there as like with your family, with hemophilia. That was one I hadn't even thought of, but you're you're spot on. Right? A lot of times we're talking about trauma care, or we're talking about patients who have cancer, we're talking about, like, neonates. So babies that are born prematurely are all kind of common patient populations that are really dependent on blood donors, but there's a whole diverse larger group.
Dr. Kreuter:You mentioned hemophilia in the past was very much dependent on blood donors. Mentioning your mother coming in for gallbladder surgery was something where people are not anticipating a transfusion. And when you talk about 8 units, I imagine if we were in a different time and didn't have those 8 units, that there would have been a different outcome. That sounds like a significant amount of somebody's blood that's circulating.
Dr. Ruby:Definitely. And so I feel so grateful that that resource was available to her to help save her life. But you're right. Like, I gave a lot of examples of emergency kind of situations like that, but there's many patients that are outpatients who this little bump is able to keep them out of the hospital and to keep them living their daily lives and to support them in a way that they can walk up the stairs without becoming short of breath. A little boost like that can help everyone stay out of the hospital and try to live as normal as a life of as they can.
Dr. Kreuter:Oh my gosh. That really is impactful for me. I mean, my time when I'm out on my own versus if I in the hospital is is night and day. Maybe I wanna maybe wrap up our conversation today by maybe asking, you know, what would you like to say to our listeners who are blood donors?
Dr. Ruby:I just wanna say thank you. Me saying thank you is one thing we also try to say thank you by giving gifts. We have, like, sweatpants. We also give away things like mugs. Every drop counts, and that is true.
Dr. Ruby:Most people try to donate out of the goodness of their heart, but we also try to say thank you by giving little things away like that. You know, there are some people who can't donate because of the restrictions of weight and age or a medical condition, or maybe you're sick and you just can't donate or you can't tolerate donation. And that's okay too. But I want people to know that even if you can't physically donate, there's still other ways that you can help. You can spread the word.
Dr. Ruby:You can encourage other people to donate your local blood collection center and help organize a blood drive. Some collection centers have mobile buses where you can send it to your school or your some organization in your community, and you can definitely help facilitate that. And if you're not willing to do that, there's other ways you can help just by supporting someone who wants to try to donate. For example, say say there's a busy parent, and you providing childcare for an hour will allow them to take the time to donate, or you could even offer a ride to someone to a donation location. So even if you can't be the one to do the donation, there are so many ways that you can help and be involved.
Dr. Ruby:And I just wanted to say thank you to all of those people too. Thank you for those who donate. Thank you for those who support the donation process. All of those efforts are so incredibly important and very much valued, and we could not do it without you.
Dr. Kreuter:We've been rounding with Doctor. Ruby talking about National Blood Donors Month, this January. A huge thank you to all the blood donors out there. As Dr. Ruby's articulated, you guys are the ultimate enablers of the medical practice these days.
Dr. Kreuter:So thank you, Dr. Ruby, for joining us.
Dr. Ruby:Thank you so much.
Dr. Kreuter:And to our listeners, thank you for joining us today. We invite you to share your thoughts and suggestions via email to mcleducationmayo.edu. If you've enjoyed this podcast, please subscribe. And until our next rounds together, we encourage you to continue to connect lab medicine and the clinical practice through educational