|
medpundit |
||
 |
 |
|
Tuesday, July 23, 2002The naiveté reached the highest levels of government. Around 11 p.m. on September 11, as an exhausted staff of the Washington-area Red Cross slumped around a meeting table, a call came in from the office of the president of the United States: Would they be so kind as to conduct a high-visibility Executive Office blood drive the next morning? Dutifully they did, on little sleep and for no practical purpose. Two days later, well after it became clear the donor spigot simply had to be turned off, they got a call from the U.S. Congress to run a blood drive among senators and representatives--and to present each member with a videotape of him or her giving blood to show constituents. Not a single unit from these collections went to the victims of 9/11. Couldn’t the Red Cross have just told them they didn’t need the blood? Evidently not. They, too, wanted to take advantage of the situation: The people who knew the most about blood tried vainly to control the flow. In order to avoid bottlenecks in the system, the Food and Drug Administration (FDA) issued emergency waivers to allow new technicians to shorten their training time and to accept blood that had not been fully tested. Such blood was labeled "For Emergency Use Only." On September 14 the Health and Human Services Department held a meeting at which the nation's leading blood-banking organizations agreed to put out a statement telling Americans to stay home and come back in a few months. They were about to issue it when the Red Cross, led by the headstrong Dr. Bernadine Healy, reneged. "What [the Red Cross] did was irresponsible and dangerous," says Dr. Ronald Gilcher, president and CEO of the Oklahoma Blood Institute. "They actually told people to keep donating." Healy adhered to the obsolete dogma that the Red Cross should never turn away a qualified donor. She also had another plan in mind. The Red Cross had been thinking about creating a frozen blood reserve to make the nation's blood supply more secure. With all the excess blood sloshing around, this might be the right time to launch it. The agency announced a crash program to freeze 100,000 units of blood. Never mind that there was no scenario under which such quantities could imaginably be used, even as a backup supply. (The military, the only population that might require such quantities, has its own independent blood system and frozen reserve.) The Red Cross quickly bought up most of the available blood freezers in the country and gutted a warehouse in Philadelphia to use as a frozen blood bank. But it was unprepared for other realities: For example, in order to freeze blood you need a glycerol solution, which protects the red cells from breaking. There wasn't enough glycerol to treat the quantities of blood Healy envisioned. The Red Cross also lacked aluminum canisters, freezing bags, and even FDA approval to utilize the process they had chosen. In the end they froze fewer than 10,000 units, while tens of thousands of others continued to accumulate and contribute to the overall waste. The subsequent revelation that the agency intended to commit $50 million of the Liberty Fund for the victims of 9/11 to the frozen blood reserve project was said to be a factor in Healy's resignation. "It was a disaster," says Dr. Harvey Klein, chief of the Department of Transfusion Medicine at the National Institutes of Health (NIH), "a total, total disaster." The author goes on to suggest some changes in the current method of gathering blood so that we have a more reliable and stable supply than we have now. The current system relies on volunteers who travel around a community setting up blood drives in schools and churches and such. The hours are always inconvenient for those who work. The author's suggestion: Maybe the Red Cross and regional collectors could lease space in hospitals to make their services more widely available, something they have never really considered. That would help compensate for the demise of the big factories and union halls that used to be the staple of community blood-giving. That probably would help year-round donations, but his next suggestion is a little iffy: Finally, we need to look for new categories of blood donors. Gay men face a lifetime ban because as a group they have a statistically higher risk of HIV. The ban is too blunt an instrument: Most gay men are perfectly healthy, and the new lab tests at blood centers can quickly detect the virus. We need to loosen that ban as aids becomes an increasingly heterosexual disease. Given that two people in Florida recently contracted HIV from blood donated by a man who had aquired the infection too recently to make it detectable by testing, we definitely should not relax that rule. We also need to accept blood from the nearly one million Americans with hemachromatosis, a genetic condition in which the body absorbs too much iron. Doctors treat this condition with phlebotomy, the only modern use for the ancient practice of bloodletting; all that precious blood goes down the drain. There's nothing inherently wrong with using that blood, which according to even conservative estimates could provide hundreds of thousands of pints per year. But because accepting it requires special FDA permission and extra expense, only 29 of the nation's more than 4,000 blood centers do so. Hemochromatosis isn’t the only condition that is treated today by phlebotomy. There is also a condition called polycythemia vera, in which the body makes too many red blood cells. They have a tendency to get all clumped up in the small blood vessels, potentially depriving essential organs of blood. The problem is, the blood taken from hemochromatosis patients and polycythemia patients may not be appropriate to give someone else. The blood of hemochromatosis patients has a higher than normal iron load, that of polycythemia patients has a higher than normal concentration of red blood cells. I don’t know enough about transfusion medicine to know if this absolutely negates their value as donor blood, but intuitively it seems that using them may impose risks on the recipients that would be better to avoid. posted by Sydney on 7/23/2002 07:35:00 AM 1 comments 1 Comments:
Hemochromatosis and Phlebotomy – Updated Blog
By |
|
