Blood donations

250 Blood donationsWhen I was seventeen and resident in a student hostel we were invited to give blood. At that age it required parental consent. I was a conformist. I got the consent first and missed that initial rush. Donation, once done, did however turn out to be habit forming. It qualified as “A Good Thing”. Various features caught the attention of my peer group. Before blood would be accepted ‘in bulk’ a few drops from a pin prick were assessed for their iron content. At each visit we were given tablets to go with meals and replace that iron. On some minor level of competitiveness it became common to ask others about their latest iron ‘reading’ and occasionally look smug. I don’t remember any competitiveness about blood pressure, which was also routinely measured. There were a few in our group who were old enough to drink alcohol, legally, and many more who thought they were old enough to drink alcohol. Being students, they were normally broke. They heard in those days as they made each donation that they should stay away from alcohol for the rest of the day. It was a short step of logic to decide that you had to get more buzz for your buck during that forbidden, often doubly forbidden, day. As the philosophers of science might say, “it was a falsifiable proposition”, and predictions are made to be checked. And as Einstein threatened to say on another occasion, “It would appear that the Almighty has passed up an opportunity”. Our young investigators continued to accept the cup of tea and biscuit that was then the orthodox reward for virtue. A stop on the way home to alter reality a bit was soon dismissed as excessive optimism.

Most of my generation had heard of needle parades in wartime where servicemen were lined up for their “shots”, and fainted just as their turn came. During WWII in New Zealand many soldiers got their very first immunisations on their way to active service. Nobody wanted to become notorious by fainting away in the blood bank. I had made several donations before I decided I might be able to watch the process. The initial pin prick made no difficulties.

The next step came then in two parts. First was a pain killer injection and then a rather more full-bore collection needle. I think it was my fourth donation before I was ready to watch the whole process. I was intrigued by an apparent little bubble of ‘local’ just under the skin in the aiming point for the ‘real thing’. I watched with interest as the full bore reinforcement was brought in. It was pushed in to locate a suitable vein and I settled back to watch collection proceed. The lady with the needle was not yet satisfied. Unknown by me, unsuspected indeed, she was refining her aim at that suitable vein. As I relaxed she suddenly pressed home her advantage. The needle went straight into the selected vein. I did not feel a thing. I saw enough and I jumped as if there had been no local in the first place. I found it necessary to apologise profusely to the lady after I had explained to her, which was after she had apologised profusely to me. It was a number of years before I was ready again to watch the process in full. In fact I don’t think I ever did.

The habit was duly formed. I visited at least seven ‘banks’ in four countries. The outline of the routine was much the same everywhere. Even the preliminary questions conformed to a standard picture. When did I last donate? Was I fit and well? Sometimes I was asked if I had missed any meals that day. Did I intend to pilot a large plane in the near future? Had I had any dental work in the last week? Did I have any unhealed cuts and abrasions? I never did get to pilot any aircraft, but I did get turned away a few days after I had a tooth extracted. I was also turned away when my son had measles, even though I had had them myself many years before. There was a slight hesitation before I was turned away on account of a snake bite the week before, though the bite itself was completely healed. The list of questions keeps getting longer every where. It is more or less like coming home from a Christmas party as a child. “Where did you go?” “Have you been a good boy?” and “Are all the people you play with good too?” “Have you made any new friends?” “Are they good kids?” You can even be asked if family members keep dropping off the twig in various unheralded ways. I think we were always conscious that somewhere along the way someone would be glad  the questions had been asked. I just hope that not too many vital questions are still missing.

In parts of the United States where blood transfusions can be expensive I would be asked if I wanted my donations credited to some particular group. Quite a number of social and church groups organise that way. The donation is available to replace blood that is used by a member or kin of the group. The user then does not have to pay. I understand that some anthropologists find this discrepancy within the English speaking world an intriguing window into the nature of society.

Also while in the United States I did not do enough homework to take up plasma donation. I could have donated plasma there much more frequently than whole blood. Memory says the plasma would have been used to relieve a hereditary blood disorder in patients with sickle cell anaemia. I just wish I had done enough homework on the spot to be sure that I made an informed decision, or maybe taken enough time to reverse it.

Somewhere along the way the pain killer needles vanished. They were followed into history by the iron tablets. The iron tablets had their own last hurrah among my less reputable acquaintance. Years later one of these confessed that he had found some tablets while cleaning up after a party at his place. In a moderately exalted state he realised that he had missed the due time to take most of them, so he decided not to risk losing them again. Down the hatch they went. I gather there was no drastic consequence. I don’t think they would even have added noticeably to the black stools that go with iron tablets anyway.

In Sydney once more I dropped into the habit of donation when the Mobile Blood Bank dropped in at Lucas Heights. I found it easier to make regular donations, and so came to be awarded recognition at particular totals. I was impressed enough with myself to wear a badge the next time I donated, and found myself in the queue next to someone who was wearing a badge of the next level up. I took mine home in my pocket and decided that the important measure of donations is one more than you have made so far.

About the time I stopped full time work I took my donation business down town in Sydney when heading elsewhere. Again the option of plasma came up and now it became convenient to drop in once a fortnight. For many uses of blood components the red blood cells are not essential. They do however take longest to be replenished in the donor. If the components are separated on the spot the red cells can be returned and the donor sent out to grow more plasma, in a shorter time before the next visit. There is a general attempt to spoil the donors rotten in the collection centre. That acted as a further incentive. I am fortunate enough to be on the majority side of most components into which blood groups can be analysed. A large group of us can donate factor VIII, an essential clotting agent not produced by people with haemophilia. I leave others to speculate how different the history of the twentieth century  would have been if that technology had been available in Russia in the last years of the Tsars.

One of the uses of blood supplies when I got into the act involved replacing all of the blood of a newborn infant. The infants concerned had the positive form of  a blood component with the magic letters Rh. At that time mothers who were Rh -ve often produced a healthy infant or two and then the trouble began. A little cross talk through the placenta, and your mother becomes immune to you. An unbalanced battle ensues, often with fatal results for the smaller party. That was common in the early sixties. Mothers immunised long ago less than happily can still make donations that shield people a lot younger from becoming similarly immunised. Complete replacement of blood can now be avoided.

As we all know, something turns up to disrupt any comfortable routine. Someone noted my date of birth and told me it was time to get an external doctor to certify each year that I was still healthy enough to continue donating. For anyone who wonders about the need for an external doctor, here is a conundrum.  I am relaxed and comfortable in the blood bank and also when talking to my GP. Why then should several GPs over a period of years consistently record my blood pressure 20  to 30 points higher than the blood bank?

The GPs in turn recently told me at my age I ought to have an extra blood test each year to monitor a few of the perils of aging.

In one case my ferritin content was just below acceptable and I was sent to the sin bin for three months. Ferritin, apart from saying “iron” did not loom on my mental horizon. I gather that in body chemistry it fits in the supply line that leads to haemoglobin. Back came iron tablets, more red meat, spinach and shortly a better ferritin reading.

I had already heard, as you do, of the magic letters PSA for prostate specific antibody, to be measured in the blood samples. Unimportant in the blood you give away, it can be an important indicator about its owner. The number indicating normal health creeps up as a [man] ages. There are basically [normal] “weight for age” readings. Your GP pays attention to these. In case of doubt and change they start to talk of “velocity”. Back I went for another test focussing on “free PSA”. I had to get my head around that. Free PSA is apparently not threatening. Other items that show up in ordinary tests as PSA are more complicated and therefore sinister. Again I came close to a marginal value and was lobbed to a specialist.

Mention of the specialist in urology changes the subject considerably. Almost immediately my career as a Red Cross donor came to a screeching halt. Prostate cancer does that. I already miss the apheresis team at the blood bank. My next great support team emerged quickly from my surroundings. It seems that the word prostate will drop into a conversation in most unlikely places. People produce uncles and ancestors. I discover many survivors among my retired colleagues. The Cancer Council once it knew about me speedily found me even more people to talk to. For the long run it has a supply of people and groups who can compare notes. Virtue is, you may have heard, its own reward. The path of virtue and blood donation requires you to look after your own health. It can lead you to early treatment of unexpected ills. Your virtuous reward may be timely and long term.

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