It was supposed to be the perfect pregnancy and delivery. After all, Lauren Larsen was a healthy, 38-year-old marathoner who had had a perfectly normal pregnancy-not even a smidge of morning sickness. But in her 37th week, she developed preeclampsia, a serious complication of pregnancy, resulting in an emergency cesarean section to deliver her daughter, Clare. And then the horror began. That night, Ms. Larsen's body shut down as her blood pressure dropped precipitously and her circulation failed. In a nutshell, she was bleeding uncontrollably through every vessel in her body.

It took six weeks in the intensive care unit, three surgeries, four weeks of kidney dialysis, and more than 200 units of blood components-red blood cells, platelets, plasma and cryoprecipitate-before Lauren finally went home to her now two-month-old baby and husband. She also went home an understandably changed woman. One with a new goal: to spread the word about the colossal need for blood donation around the country.

Ms. Larsen knows she was lucky. She knows that she has the hundreds of strangers who had unselfishly donated their blood to thank for her very survival. But what she doesn't know, or doesn't understand, is why so few people step up to the blood bank to do what those volunteers did: take an hour, hold out their arm and donate their blood.

All told, 4.5 million American lives are saved each year with blood transfusions, and an estimated 38,000 units-5,000 gallons-of donated blood are used each day in the U.S.¹ Yet even though about 40,000 Americans donate blood each day, that's barely enough to keep the health care system running, notes James P. AuBuchon, MD, medical director of the Blood Bank and Transfusion Service at Dartmouth-Hitchcock Medical Center in Lebanon, NH. Dr. AuBuchon is also the chair of the Clinical Transfusion Medicine Committee of the American Association of Blood Banks, a professional society devoted to education, standard setting and accreditation associated with blood collection and safety.

Despite the patriotic outpouring after the September 11, 2001, terrorist attacks, when 500,000 Americans donated blood,¹ this country's blood supply runs on perilously thin margins. "We've seen an increase in the number of times a year during which the blood supply runs dangerously short," says Dr. AuBuchon. "It used to be only after the holiday period and at the end of summer, when people are on vacation. But now we're seeing more frequent appeals for donations just because supply has not kept up with demand."

It wouldn't take much to improve the situation. Just a five percent increase in the number of people who donate-about 40 more people in each state every day-would be enough to pull the nation's blood supply from the brink of disaster, he says.

Shrinking Donor Pool
A major reason for the blood shortage is that even though 60 percent of the country's population is eligible to donate blood, only about five percent does.¹ There are three main reasons for the shrinking numbers, according to Louis M. Katz, MD, president of America's Blood Centers.

1. Changing demographics. "The generation that we have always depended on since the 1950s to give blood, the World War II generation, is getting older and fewer," says Dr. Katz. Baby boomers and the generations that follow just don't donate as much. "Whether that's because of a difference in lifestyle or a difference in the level of altruism, or because we as a blood community are not effectively appealing to these generations, isn't clear," he says. "But it's probably a bit of all three."

2. Increasing need for blood. As surgeries become more complex and cancer treatments more aggressive, and as people live longer, this country uses about five percent more blood every year, explains Dr. Katz.

3. Increasing blood donor rejection rate. Beginning with the AIDS epidemic in the early 1980s, the blood supply has gotten much safer. But that's required turning away more and more potential donors. "We have increasingly sophisticated and sensitive tests, and we're asking all kinds of questions that weren't asked before," notes Dr. Katz. For instance, people who have spent three or more months in the United Kingdom between 1980 and 1996 cannot donate blood for fear they could introduce the human version of mad-cow disease, Creutzfeldt-Jakob disease, into the blood supply. "It's a death of a thousand cuts," says Dr. Katz. "Every little thing we do to make the supply safer takes a little more off that margin of availability."

There are other reasons as well. For instance, a study evaluating why people don't donate blood and other organs found that a persistent mistrust of doctors and hospitals and religious misconceptions played a major role. Minorities were particularly likely to avoid donation for these reasons. The study, which involved 20-minute phone interviews with 339 Baltimore, MD, residents, found that African-American and Caucasian women were less willing to donate blood than Caucasian men (36 percent compared to 86 percent). However, only 41 percent of African-American women surveyed said they would donate blood.²

Breaking Down Barriers to Donation
"The greatest barrier that prevents people from donating is a lack of convenience and a lack of knowledge of the importance of donating," says Dr. AuBuchon. A recent survey conducted by the American Red Cross found donors want to donate at or near a hospital, and generally don't want to travel more than 10 miles to donate.³ That's further reason why the American Red Cross, along with other blood banks, do all they can to bring opportunities to donate to the donors, through work-site and community blood drives, rather than requiring donors to travel to them.

"Once we get into the community sites we're accommodating women who are at home as well as at work," notes Linda A. Chambers, MD, senior medical officer at the American Red Cross' biomedical headquarters in Washington, DC. That's vital, she says, for as family caregivers, women hold a lot of influence when it comes to blood donation. "When a woman donates blood, the message to others is that it is safe and painless and appropriate," says Dr. Chambers. "It's a message that blood donation is a nurturing, selfless and kind act that is very much within the traditional role of women." Also, women receive 53 percent of all blood transfusions.¹

The American Red Cross survey found that women 17- to 19- years-old are more likely to donate than men in the same age range. But at the other end of the spectrum-the 65- to 74-year-old age range-they are significantly less likely to donate. And when it comes to overall annual frequency of blood donation, men outpace women, donating an average of 1.68 times a year, compared to 1.53 times a year for women.

One reason for the gender differences may have to do with the fact that women who are still menstruating are more likely to have lower blood iron levels than men, says Dr. Chambers. And iron levels are important when it comes to blood donation. The U.S. Food and Drug Administration (FDA) requires that all donors have a blood hemoglobin level of at least 12.5 g/dL, Dr. Chambers notes. So about eight out of every 100 people who turn up to donate blood-nearly all of them women-wind up being turned away, or "temporarily deferred," because of low hematocrit, or red blood cell, levels. Overall, about 30 percent of women who try to donate blood are temporarily deferred.⁴

That doesn't mean women can't eventually donate, notes Dr. Katz. They just need to get their red blood cell levels up either through diet or supplements. His organization is testing a program in which women with low hemoglobin levels receive a supply of supplemental iron to take at home. When they finish the last pill, they're eligible to donate again. The hope is that this will not only improve a woman's hemoglobin level, but also increase the number of women who donate after deferral. Currently, few temporarily deferred people ever return to donate.³

More blood centers are beginning to offer something called "double red blood cell donations." These are a different type of blood donation where, instead of collecting blood into individual collection bags as it comes from the donors' veins, it's collected into a machine. The machine keeps just the red blood cell portion of the blood and returns the other blood elements to the donor. "By doing this, the donor is able to give all of his or her donation as red blood cells (instead of red cells and plasma) and, if he or she has a large enough total blood volume, two full doses of red cells can be collected at one time," says Dr. Chambers. "This allows us to get twice the most important part of the donation from high-priority donors such as group O-negative." Best of all, donors only have to come in once to give the equivalent of two donations.

Unfortunately, many women do not qualify to donate double red cells, says Dr. Chambers, because their blood volume is too low. "But for those who do qualify, double red cells are a nice option."

A Growing Crisis
In a 2000 report from the National Blood Data Resource Center, nine percent of the nation's hospitals reported at least one day in which they had to cancel or postpone elective surgery because of a lack of red cell units, says Dr. AuBuchon. Half of those hospitals had to do this for at least two days. Additionally, one-fourth of the hospitals could not meet their non-surgical blood requests at least one day, and for those experiencing such shortages, half were not able to meet it on at least five days.⁵ "I can tell you that, since then, things have gotten worse, not better, in terms of the blood supply," he says.

Overall, all agree, the nation's blood supply is shrinking at the very time when it is most needed. Lauren Larsen, who now works full-time spreading the word about blood donation, sees that clearly. As to why she's chosen this as her life's focus, the reason is simple: "I realized that people gave of themselves through blood donation to keep me alive. So now I spend my time speaking at events across the country to recruit more blood donors as a way of helping future blood recipients," says Ms. Larsen.X

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© 2003 The National Women's Health Resource Center. All rights reserved. Reproduction of material published in the National Women's Health Report Online is encouraged with written permission from NWHRC.

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