History was not my ally when I entered Blood Centers of the Pacific in downtown San Francisco. The first time I'd donated blood, 10 years earlier in my high school gymnasium, I found myself breathing into a paper bag after a fit of hyperventilation. The next time, three years ago, I nearly fainted at a blood drive a friend had organized. His smile dropped when he saw me lying prone, a cold compress on my forehead, my face as white as the side of the blood bank truck.
This time, when I approached the front desk, I learned that my name had been flagged. My reputation, I feared, preceded me. I'd been disqualified for my lack of fortitude during previous blood givings, and I'd be unceremoniously sent away. But the truth, it turned out, was much better.
"Were you aware you have AB-positive blood?" Blood Centers of the Pacific Technician Dennis Crader asked me. "Only four percent of people are AB-positive. This means you're a universal plasma donor: Your plasma can be used to help any patient in need."
I was not being sent home. Rather, I was being asked to fill a spot on their all-star donor roster, and they signed me up for a plasma donation appointment the following Monday. Pride pumped in my veins. I walked out the door feeling like a celebrity, and spent the weekend psyching up and hydrating like a marathon runner. (Plasma, which is 90 percent water, makes up 55 percent of your blood, and they were going to take a lot of it out of me.)
Anyone can donate plasma, but most people make better whole blood donors. The vast majority of people are either O-positive or A-positive, so most other people can receive their red cells in a transfusion. My red cells -- what you give in a standard blood donation, and what I'd given before -- were virtually useless, Dennis explained. Only those with AB-positive blood could receive them. But my plasma -- the liquid and protein in blood -- was special. Doctors use plasma, an essential building block in blood clotting, for hemophilia emergencies, accidents or surgery involving severe bleeding, and cases of liver failure.
Even during times of unprecedented donation, blood is at a premium. While half a million people donated in the weeks after September 11, 2001, that overabundant supply was short-lived -- red cells, which do not stand up to being frozen, keep for only about 30 days. Plasma, which can be frozen, has a shelf life of one year, but is usually sent out to patients within days, because relatively few people donate it. Of the 38 percent of Americans eligible to donate, only 8 percent do -- and even fewer donate more than once a year.
My plasma was to be drawn through an elaborate process called plasmapheresis, or apheresis. There are plenty of disqualifying factors, I learned. Before getting to the giving chair, you've got to "pass" a few routine tests (temperature, blood pressure, pulse, iron level) and answer an elaborate questionnaire. If you're going to give blood, you should be prepared for this questionnaire. It's long, and some of the questions are strange. "Since 1980," one question asked, "have you received an injection of bovine insulin made from cattle in the United Kingdom?" Other questions are quite personal, involving your sex life and illicit drug use.
On this day, my only hurdle was iron level. The blood bank requires a minimum of 38 percent iron in your blood. On first draw, I weighed in around 35 percent, flirting with anemia. I cursed myself for not having steak at breakfast, but a second reading put me at 39 percent. My blood had rallied with a late surge of iron, like a track star finding another gear in the last lap.
"We're in!" I whispered to my veins as we headed for the row of luxurious chairs reserved for plasma donors.
Red blood cells can go home again
When the needle went in my right arm, I had a brief moment of panic. My mouth went dry. I was dehydrated already! But soon a strange calm came over me. First of all, the employees at Blood Centers of the Pacific are not just blood technicians -- they're also apparently trained in reassurance. Between their voices and the heated armrests -- similar to seat warmers in a car -- I actually felt comfortable with blood pouring out of my arm. (Dennis told me someone had once conducted a conference call during his apheresis, so you can pull off some creative multi-tasking from the chair.)
No stranger to blood (parts of my youth were dotted by near-daily nosebleeds), and familiar with needles (I received allergy shots for five years running), I was still grateful for the comforts the blood bank provided: the heavy blanket that covered my needled arm, the heated armrests, and the hot tea. All of them keep at bay the general chill some people experience throughout the process. The genius of the apheresis machine is that it takes your whole blood and separates it into different parts, depending on what they want from you, and then gives the rest of it back. In my case, this meant taking my plasma and giving back everything else (red blood cells, white blood cells, and platelets).
The tube taking the blood from your arm feeds the machine. On its way, this tube branches and your blood is mixed with sodium citrate, an anticoagulant. Without the anti-clotting sodium citrate, reintroducing your blood cells would be impossible.
In the center is the centrifuge, spinning at 7,000 rpm. The jackpot, my sought-after plasma, separates out and collects in a bowl beneath the centrifuge, where it is fed into a tube and then into a bag. Before any of this happened, the blood bank assured me there was no chance of contamination from another person's blood. For each plasma donor, there's a single-use plastic kit. Even while it's being spun in the centrifuge, your blood never comes in contact with the machine or another donor's blood, they told me.
I've heard plasma described as "straw-colored," but my best comparison -- sorry -- was to urine. The plasma collects in the bag, slowly, until they've got 680 cubic centimeters (ccs), or a little over a pint. A pint is the rough goal, and that much can be separated into three parts for use in patients. Depending on your weight, they'll take a little more or less. Also, the more hydrated you are going in, the fewer intervals, and less time, will be needed.
At planned intervals, the machine reverses itself. I felt the pressure on my upper arm slacken, meaning my veins were "opening up" again for the big event: I was getting my red cells, white cells, and platelets back. I grew concerned. Would these blood parts, having tasted life on the outside, ever be happy again in my hometown veins? Coming back down the tube from the big spinning city of the centrifuge, were they unenthused to drag along through the boring streets of my bloodstream?
But everything felt perfectly normal. It's really a testament to mind and body: One, to whoever figured out how to engineer such a feat, and two, to the human bloodstream for having the resilience to keep functioning as if nothing out of the ordinary has happened. It's miraculous to me that they can take your blood out and put it back into you, and you can just get up off the chair and go back to work.
A half-hour later, after three give-and-take cycles, Dennis told me they had all the plasma they needed. Next came the creepy, but oddly scintillating part. In order to replenish some of your plasma, they mix your last return of blood cells with 500 ccs of saline solution, a common intravenous fluid. I watched the blood in the tube quickly change from dark red to a shade of pink as it was sent back to my bloodstream. The effect of this, the feeling of receiving this "watered down" blood, is literally like ice in the veins. I was, for about thirty seconds, cold-blooded. A reptile. You don't get to feel that every day.
Piece of cake -- or a donut
When Dennis took the needle out, there was no sweating or hyperventilating. No fleeting thoughts that this was it for me. Just the fine feeling a good deed brings. "I think I'm ready to leave now," I said to the smiling volunteer. I accepted the donut she offered and walked out of there on sturdy legs. While apheresis is a longer and more elaborate process than standard donation, it seems you're less likely to suffer ill effects once it's over, since you get all of your red cells back. I felt so good that I walked all the way back to work where I completed a normal day, as if I hadn't just had my circulatory system overhauled. My souvenirs included a bandage on my arm and a t-shirt pronouncing me part of the apheresis team. I proudly told my co-workers all about it.
Since then, I've been back once (plasma donors can give as frequently as once a month). The last time I was there, a woman came in with AB-positive blood, and Dennis gently tried to convince her to donate plasma. From my reclined position in the chair, I explained my checkered donation history -- and the trepidation I'd felt about giving again. "But I'm here to tell you, this is nothing. A real piece of cake." Amazingly, I'd gone from hyperventilating basket case to beatific spokesperson. I can't think of a better convert testimonial than that. I don't know if I'll see her in the chair next to me when I go in for my next donation, but I hope to.
If you're going to give blood, you should know what to expect. The American Red Cross has a wealth of information, including a list of disqualifying factors: http://www.redcross.org/
To sign up to give blood:
Blood Centers of the Pacific: 888/393-GIVE
American Red Cross: 1-800-GIVE-LIFE
America's Blood Centers: 1-888-USBLOOD
"Blood Banks Issue Urgent Appeal," Associated Press, Jan. 14, 2003
Interview with Dennis Crader, apheresis technician, Blood Centers of the Pacific, November 2002
"Red Gold: The Epic Story of Blood," KQED Public TV and Radio, http://www.pbs.org/wnet/redgold/index.html
American Red Cross. Donation FAQs. http://www.redcrossblood.org/donating-blood/donation-faqs
Americas Blood Centers. 56 Facts About Blood (2007). http://www.americasblood.org/go.cfm?do=page.view&pid=12