The life of all flesh is in the blood thereof – Leviticus 17:14
Blood. In some it inspires fear; in others, fascination. So essential to our concept of bodily existence, it is the synonymy of life and death. Our species’ ritual, art and science have been steeped in it for millennia, and while, as Shakespeare wrote, “blood will have blood,” even those that go bump in the night know, as Bram Stoker added, “the blood is the life.” It is from centuries of both battlefield need and morbid fascination that we are able to utilize blood in a lifesaving way—by intravenous transfusion.
From cannibalism to Catholicism, the consumption of blood is inexorably tied to attaining vitality. But for those in medical need of blood—such as by blood loss due to surgery or trauma, or for the treatment of blood diseases like leukemia or sickle cell anemia—blood’s vitality is literal, and there is no substitute for it.
WHAT IS BLOOD?
Blood is considered a specialized connective tissue, the body’s hydraulic system, which acts as transporter, repairman, messenger and waste remover. Whole blood consists of three basic types of cells—red, white and platelets—all of which are created in bone marrow and suspended in plasma (the aqueous base accounting for 55 percent of whole blood’s makeup). Mostly water (about 90 percent), plasma contains and circulates proteins and lipoproteins as well as other essential components such as immunoglobulins (antibodies), trace minerals and electrolytes.
Of the three types, red cells—or erythrocytes—are the most common. Within the membrane of these jelly donut-esque cells, in the cytoplasm, is the iron-containing metalloprotein, hemoglobin. Oxygen binds to (and is thus transported by) hemoglobin, fulfilling the erythrocyte’s most essential function. The iron of hemoglobin gives these cells their characteristic red color, and a deficiency thereof is known as anemia.
White cells—or leukocytes—are a well-known component, though the least prevalent in whole blood. We know them as the knights in shining armor of our immune system, though electron microscopes reveal they look more like snowball pastries that got stiffed on the full serving of coconut. There are several types of leukocytes and, as with any army, each are specialized warriors. Neutrophils, for example, target bacteria and fungi, while basophils address necessary inflammatory responses by releasing histamines. Malignancy of these cells is known as leukemia.
Platelets—or thrombocytes—are a curious cellular constituent. Anuclear (without nucleus), they resemble dollops of coleslaw and are key in hemostasis (blood clotting). Thrombocytopathy refers to abnormalities with platelets—too high of a count, and vessels can become blocked, too little and excessive bleeding and bruising occurs.
When any of these multifarious, delicately balanced functions are compromised by disease, or when the quantity of blood the body needs to churn through its cardiovascular system (about 5 liters) is depleted, intravenous transfusion is a do-or-die necessity.
But, as tied to life as blood may be, blood has a life of its own—literally. Erythrocytes, for example, take seven days to develop and mature, then live for about 100 to 120 days in circulation. Thrombocytes, on the other hand, only live for about eight to 12 days. This means, in short, that blood is perishable, posing challenges for collection and usage.
Living blood—without substitute and beyond synthesis—can thus be attained in only one way: donation.
Two, simple words: Volunteer Donor.
It is as if the label imprinted with those words has unstuck itself from the blood bag, and is now fluttering in my field of vision like a proud moth—its bold proclamation black and broadcast on white wings. Volunteer Donor.
“Is there any other kind?” I ask my pair of nurses. They are, with great professional ceremony, connecting the contents of the blood bag to the peripheral IV in my left arm.
Laughing inquisitively to indicate a need for clarification, they ready themselves to kindly field yet another question; one of a volley I’d hurled since my arrival at Maui Memorial Medical Center just a few hours prior.
“I mean, are there involuntary donors? Where does this blood come from?”
Every drop—unless banked by me in advance, say, in preparation for surgery—came from local, volunteer donors during blood drives, the nurses explain.
“Do we know who they are? Can they be reached? Can I thank them?”
The nurses crumple their chins and lower lips, shaking their heads saying that I could not. Reasons of anonymity, privacy and things of that nature. Still, it was all I could think of, those two words. Volunteer Donor.
The blood bag hangs, its bottom bulbous with viscous weight. As the blood drips into a cylindrical chamber before conjoining to a tube twain to a bag of saline, the color diffuses. It is at first coffee berries in Kula dew, then ohia lehua cast in shadow and finally hibiscus in Lahaina sun.
With every churn and click of the IV pump, the blood creeps closer to my veins. I lie, barely breathing, watching the slow crawl. The blood drips on, but the realization is a wave. Right now, someone else’s blood is in my body—and right now, it’s saving my life.
Despite my refusal to accept the truth—I have cancer, leukemia to be exact—I needed blood and I needed it soon. Not necessarily because of any losses I’d experienced (the more than a month I’d spent trying to hide the fact I woke every morning with a mouth full of blackened blood or that with the slightest nick, I’d ooze red all day), but because my blood is doing something highly abnormal, and only good blood—from someone else—could stave symptoms and provide treatment for what would otherwise eventually kill me.
This transfusion of two units—the first in what will, over the next month, amount to dozens—takes all night. Each unit is 450ml, and must run slowly into the system, taking about four hours.
Morning comes. The last bag flattens as its contents dwindle, the faint mottling of bubbles like tempera paint blown and popped on paper in grade school. In the last eight hours I didn’t sleep, but instead watched color return to my skin, my arms flushing pink as if I’d smeared on a thick layer of Calamine lotion. I’d forgotten, until now, what it was like to feel good.
I remain hospitalized on Oahu for five weeks, largely due to my medical need to be close to a blood bank. The Blood Bank of Hawaii is based entirely on Oahu and services 19 civilian hospitals throughout the state—eight of which are based on outer islands. However, the highly regulated storage and processing of blood can only be handled through a blood bank, and for patients like myself, Oahu hospitalization eliminates the foul prospect of not being able to acquire the right blood at the right time. Though it is the best healthcare choice, this distance adds financial and emotional burden to outer island patients and their families, already under duress.
Meanwhile, outer island donors are inconvenienced by their limited opportunity to give blood. Though restricted to donating at a minimum of 56-day intervals, donors are relegated to a specific few days of blood drives, held but once every other month. This can clash with schedules and discourage participation.
Challenges aside, Blood Bank of Hawaii’s Oahu-based operation has saved a lot of lives statewide since 1941.
Two months after my first-ever transfusion, home again on Maui, I am at the Cameron Center. The Blood Bank of Hawaii is holding a four-day blood drive, for which a specially trained crew and their equipment have been flown in. Maui donors have come out in full force.
These drives require not only lodging and transportation for the large crew, but for the blood itself. Given blood’s perishable nature, the blood bank relies heavily on the support of Hawaiian Airlines, with whom they schedule regular shipments every couple of hours, explains Rose Espina, the crew’s team leader on the third day of the drive.
Before shipping, Espina says they divide the blood into about ten segments, wrapping and packing the segments in ice. She points to a neat stack of empty white boxes, labels and packaging prepared in advance.
It’s barely past midday and they’ve already worked with over 90 donors. Exceeding their goals (though there is always need and room for more), their daily count has numbered between 135 and 145 donors per day. Managing such volume, the impressive crew works with speed and polish.
As impressive as the blood bank’s satellite operations are, I am distracted by the fact that I am standing in a room full of Volunteer Donor, amidst the very people who saved my life and the lives of countless others.
Most immediately apparent is how diverse the donors are. It’s the kind of spirit-lifting mix usually only seen in TV commercials—people of all ages and ethnicities, their dress and demeanor suggesting a slew of occupations from construction workers to executives, retirees, students and teachers.
There is something very telling about they way they all sit so patiently and politely, awaiting their appointments. Then, I notice how each and every one of them, upon standing when their name is called, smiles.
“It’s one of the last idealistic, altruistic things you can do,” a long-time donor tells me as we chat after his appointment. He’s given “a couple of gallons,” here in Hawaii, cleverly adding he’s left a half-dozen gallons back on the Mainland, too.
“I’m healthy as a horse. Nothing precludes me from doing it. It doesn’t hurt me,” he says. “Anyone who is strong enough to do it, and has time, should.”
“Sometimes you don’t really realize the meaning behind it all—how it really is like paying something forward,” says a female donor, as she rejoins her husband outside for refreshments. Her husband says they’ve donated individually for years, but that this is the first time they’ve come as a couple. Enjoying the time spent together, they plan to share the experience more regularly.
The next day, the drive has moved to Maui Economic Opportunity, just up the street. It’s a steamy, Christmas Eve morning and the room smells of Portuguese bean soup, apple pie and warm manju.
“We thought it would be a nice way to spend the holiday,” says one young man—a first time donor—who is there with his long-time donor father.
“I can’t surf today,” he continues, of having to take a break from the waves so as to comply with the recommended 24-hour refrain from strenuous activity, “but it’s worth it.”
I also meet several professional women, having planned their appointments during their lunch breaks, and another woman who is there serving up refreshments.
She’s a century donor (meaning she’s given blood more than 100 times), and insists I take a bowl of soup myself, before I ask her how she first became involved with the blood bank.
“My baby needed blood,” she says, of a hospital experience in December 1972. “When was all pau, they neva like money, just wanted da blood back. So I gave blood, and that’s how it started.”
She continued giving—109 times—plus began volunteering by placing friendly reminder calls to donors about upcoming appointments, and taking up shifts attending the food and beverage canteen.
“I was [deferred] for a little while because of my eight-pound tumor,” she says, tapping her chest. My eyes widen, but she shakes her head. “No, no, no. It’s OK now. But it looked like a clamshell, in my chest. Eight pounds,” she taps again, grinning. “I’m just happy I can give something—volunteer, give blood—you know, whatever I can.”
I’m overwhelmed, feeling both unendingly grateful and a little embarrassed. I fight the urge to shout and hug each of them, to lift and kiss their punctured forearms, and thank them for their selflessness. All of them, my personal heroes and those two captivating words, embodied.
HOW CAN I DONATE?
Every two months, Blood Bank of Hawaii conducts a blood drive on Maui. Call 800-372-9966 to make an appointment. Though not mandatory, appointments are highly recommended to reduce your wait time and keep things flowing smoothly. The entire process takes about an hour, including paperwork, a mini physical and confidential consultation. The blood draw itself takes only five to eight minutes.
Relatively simple as the process may be, there are some important preparatory and follow-up care considerations that need be made by donors—particularly during the 24 hours surrounding donation. Fortunately, the three major recommendations are commonsense practices: hydration, proper diet and plenty of rest.
Hydrating with that other essential liquid is key. The Blood Bank of Hawaii sticks by the ol’ “8 by 8” rule—you know, eight, 8-ounce glasses of water per day. Doing that—plus staying away from caffeine, alcohol and cigarettes, which are dehydrating—will replenish fluid volume loss within 24 hours, with proteins and plasma replenishing in 72 hours and red blood cells regenerating in six weeks. If chuggalugin’ that much wai—though you know you need to—seems daunting, no feel shame in dressing up the occasion with lemon or lime wedges, fruit cubes, cucumber slices or mint.
As part of the pre-examination, donors undergo a simple finger-prick test that instantaneously assesses iron levels in the donor’s blood. Too low a level, and donation may be deferred. So, first fueling with iron-rich food is also fundamental. The blood bank, in a pamphlet promoting healthy hemoglobin, provides a table of about four dozen foods that help build iron, listing grinds like red meat, fish steaks, berries, watermelon, beets and brown rice.
And, according to the United States Department of Agriculture’s National Nutrient Database, nothing tops mollusks for iron-packing abilities (and I know opihi are limpets, but I’m tossing them in the same category…with shoyu and Tabasco). With an average of 23.77mg in a three-ounce serving, it far outstretches turkey (11.18mg per cup), chicken (10.21mg per cup), duck (5.97mg per half-duck), beef (0.69 – 5.24mg per cup) or fish (2.48mg per three-ounce serving).
To aid in the absorption of iron—especially “non-heme” iron, or iron that does not come from the hemoglobin and myoglobin in meat—pair iron-rich foods with foods high in Vitamin C like citrus juices and papaya. Non-heme iron accounts for the majority of regular intake, and undergoes a chemical reaction when paired with Vitamin C, as well as with other heme iron foods, that allow for absorption.
Rest, too, is imperative. After blood is drawn, it’s important to rest for a few minutes and to avoid strenuous physical activity for at least 24 hours. As for vices, apply the pool-rule: if you must return to bad habits, wait at least 30 minutes after your donation.
Beyond bodily care, it’s imperative for a donor to know thyself. Stringent quality control rules are in place by the FDA and enacted by the exhaustive efforts of blood banks. International travel, for example, can defer donation. Travel to South America or Africa will require a possible12-month wait from your return to the United States, and after travel to Europe (new FDA regulations introduced in 2002), deferment may be indefinite.
Questions about medical conditions and medications taken are addressed in the questionnaire and during the confidential consultation, but many general cans and no-cans are outlined between the Blood Bank of Hawaii, America’s Blood Centers and the FDA (contact any of those organizations for specific info).
If you are deferred for any reason, there are many more ways to become involved and save lives. The most important is advocacy—encourage family and friends to donate the gift of life.