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Are Nationwide Blood Appeals Needed?

Doctor calls them unnecessary and potentially dangerous

WEDNESDAY, Feb. 20, 2002 (HealthDayNews) -- As the nation reeled in the immediate aftermath of the Sept. 11 terrorist attacks, Health and Human Services Secretary Tommy Thompson issued a strong plea.

"I encourage all Americans to help out in this time of crisis and donate blood," he said. "No matter where you live, your blood donation can help those in need."

A Florida pathologist now says that move was the wrong one. He calls it inefficient at best and, when officials temporarily eased blood donor screening measures, potentially dangerous to the very people the government was trying to help.

"Every time there's a disaster, I hear the same thing: 'All those wonderful people who gave blood'," says Dr. Paul Schmidt. "Nobody ever talks about what happened to the blood or was it needed."

Schmidt, a pathologist at the University of South Florida in Tampa, decided to answer those questions for himself.

In an article in tomorrow's New England Journal of Medicine, he analyzes the blood donor response to five major U.S. disasters: the 1981 collapse of a skywalk at the Kansas City Hyatt Regency that killed 114 people and seriously injured 188; the 1989 United Airlines plane crash in Sioux City, Iowa, which killed 111 people and left 185 others hospitalized; the Oklahoma City bombing in 1995 that left 167 dead and sent 83 to the hospital; the 1999 shootings in Columbine High School, in Littleton, Colo., in which 15 people were killed and 30 others wounded; and the Sept. 11 attacks, which claimed 3,173 lives and injured approximately 4,000 people, including 200 who were hospitalized.

In the four disasters before Sept. 11, blood collection was managed locally, Schmidt says, and officials didn't feel the need to call for donations on a wide scale.

In all those disasters, hospitals transfused fewer than 500 units of blood, an average of about 120 each event. Blood donation was impressive, with roughly 13,000 units collected, but the vast majority of those came in Oklahoma City.

After Sept. 11, donation sites nationwide were flooded with both people and blood. After Thompson's appeal, the Food and Drug Administration (FDA) briefly authorized volunteers to screen donors, allowed shipping of unlicensed blood products, and said it would permit transfusion of blood that hadn't been completely tested.

The American Red Cross, which had earlier stated that it had 50,000 units on hand and didn't need emergency supplies, and America's Blood Centers launched massive blood drives. Even the White House called on its employees to donate.

The FDA rescinded its relaxed screening and testing rule on Sept. 14, and Schmidt says he knows of no one who received tainted blood as a result of the policy. But the bigger concern, he says, is what happened with all the blood that was collected in the national drives.

Centers nationwide amassed 475,000 units between Sept. 11 and Oct. 14, a 287,000-unit increase over that period the previous year. But only 258 units were transfused, mostly in patients in New York, Schmidt says.

The Red Cross, which normally throws away about 3 percent of its collected blood, had to discard almost 50,000 units, or 17 percent, of the 287,000 it couldn't use. That figure doesn't include blood that was shipped to hospitals but not used, Schmidt adds.

Schmidt blames the inefficiency on the lack of a single voice directing potential donors. "The earlier disasters happened in communities where there was really one blood voice in the community. People knew who to turn to," he says.

"What we need," he adds, "is a system that organizes people to give regularly. We're missing an opportunity to do that nationally."

Lost in the emotional display of bared arms to help victims of the attacks, Schmidt says, was the fact that the blood that helped save people's lives was donated before the tragedies happened by people who make a habit of giving. "Nobody's thanking them. They're thanking people who rushed out emotionally," he says. Blood donation has dropped to pre-Sept. 11 levels, according to a recent figures from the National Blood Data Resource Center.

Schmidt's complaints, however reasonable, strike some as Monday-morning quarterbacking.

Bill Pierce, an HHS spokesman, says the agency's call for blood was rooted in the apparent magnitude of the tragedy, the uncertainties of not knowing how many people would need transfusions, and whether additional attacks might follow.

"Once we got past that, at the point when people were lining up for hours [to give blood], the Secretary started to say, call and make an appointment" to donate, Pierce says. Thompson also began stressing the importance of becoming a regular donor, hoping to channel the sympathetic outpouring into a consistent reservoir of blood donations.

"It was a really uncertain time," says Allan Ross, vice president for technical operations at the American Red Cross in Roslyn, Va. "Hindsight will tell us that we really didn't need as much blood as was collected, but we didn't know that at the time."

Ross says his agency has "no regrets" about the way it handled itself in the wake of Sept. 11.

Still, the Red Cross, the American Association of Blood Banks and other blood collection groups have created a task force to centralize the nation's response to major disasters. The group, whose members also include representatives from several government agencies, will coordinate with HHS to issue a unified message after an incident, Ross says. It will also act as the single liaison to local communities, and in return be the sole mouthpiece for community groups offering help to affected areas.

Karen Shoos Lipton, chief executive officer of the American Association of Blood Banks, says the purpose of the task force is "to try to manage blood donation during a disaster and make sure that we're collecting to need and no more."

That's not always possible, Lipton adds, but in general "getting a mass of people in who are not pre-screened is not particularly helpful." Although centers can handle the surge in donors, "we make more mistakes" by relying on untrained staff to deal with the influx.

Ultimately, Schmidt's primary concern -- having ample routine deposits to fill blood bank coffers -- is widely shared. Fortunately, says Lipton, on Sept. 11 the supply of blood was strong. "If we ever have a disaster where we don't have good inventories, we are going to be in trouble," he adds.

What To Do

Blood groups are always looking for regular donors, who can give once every 56 days.

For more on the blood supply, try the American Red Cross or the American Association of Blood Banks.

For more blood supply facts, try the National Blood Data Resource Center.

SOURCES: Interviews with Paul Schmidt, M.D., professor of pathology, University of South Florida, Tampa; Allan Ross, vice president for technical operations, American Red Cross, Roslyn, Va.; Bill Pierce, spokesman, U.S. Department of Health and Human Services, Washington, D.C.; Karen Shoos Lipton, chief executive officer, American Association of Blood Banks, Bethesda, Md.; Feb. 21, 2002, New England Journal of Medicine
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