National Blood Donation Month: How donations travel after taken from arm

  • Individual pintes of blood begin the filter process that separates red and white blood cells at the American Red Cross facility in Dedham, Massachusetts. GEOFF FORESTER—Monitor staff

  • American Red Cross lab assistant Mohammad Ghory hangs up a pint of blood as he labels intake to be processed at the Dedham, Mass., facility.

  • American Red Cross Director of Manufacturing Edward Roberts Jr. stands in front of the O-negative storage space that is almost empty. O-negative is the rarest type of blood and the hardest to keep in supply. GEOFF FORESTER—Monitor staff

  • Boxes of blood are ready for shipment at the American Red Cross facility in Dedham, Mass., on Wednesday, January 10, 2018. GEOFF FORESTER—Monitor staff

  • American Red Cross Director of Manufacturing Edward Roberts Jr. stands in a refrigeration room, where white blood cells are filtered out of bags of red blood cells at the Dedham, Mass., facility on Jan. 10. GEOFF FORESTER photos / Monitor staff

  • American Red Cross Director of Manufacturing Edward Roberts Jr. stands near the blood separator in the lab at the American Red Cross facility in Dedham, Mass. GEOFF FORESTER / Monitor staff

Monitor staff
Monday, January 22, 2018

The needle has been pulled from your arm and the Red Cross nurse walks away with the plastic bag carrying a pint of your blood. It’s just like every other time you have donated, which hopefully is a lot of times because a constant supply is needed.

But this time a few questions come to mind: What’s going to happen to it? Does it get mixed with other people’s blood? Does it come back here, or does it get used by patients somewhere else? Where exactly is it going, anyway?

Good questions, those. And since this is national blood donation month, the Monitor thought we’d find out.

The answer: It’s going to Dedham, Mass. To start with, anyway.

Manufacturing facility

Dedham, on I-95 southwest of Boston, is home to a huge blood donation facility that also houses the Red Cross manufacturing center for all the blood collected by the Red Cross in New Hampshire as well as all of our neighboring states – more than 300,000 pints a year.

Wait – was it called a manufacturing center?

“People wonder about that word,” admitted Edward Roberts Jr., a 38-year Red Cross veteran whose title is Director of Manufacturing for Massachusetts and Northern New England, during a tour of the facility last week.

As Roberts explained, the word is appropriate because whole blood, the stuff taken directly from our bodies, is almost never used in emergency rooms, surgeries or hospitals anymore. Instead, in a process that has parallels to the way raw materials are shaped and processed into more valuable items, each pint we donate is processed and divided into useful components: the red blood cells that carry oxygen; the liquid known as plasma; platelets, which cause clotting; and a concentration of plasma called “cryo” that has special clotting factors.

This separation is why the Red Cross likes to say that each donation can help save up to three lives.

The other main component of blood – white blood cells, the front line of disease-fighting capabilities – are filtered out and discarded because of compatibility issues between donors and patients. The Dedham facility has a lab that is studying what is known as HLA, a protein on these cells surfaces, for its use in boosting people’s immune systems.

Each of these blood components must be prepared in different ways and stored in different ways – plasma and cryo can be frozen and kept for up to a year, platelets can be kept at room temperature but have to be constantly shaken to keep from coagulating, and red blood cells can last only about five days, even in temperature-controlled rooms.

That’s the job of the Dedham facility, which since 1986 has been the heart of the Red Cross blood collection and distribution for New England. The building also has some other Red Cross facilities, including a large area for people to donate.

More than 300,000 pints a year

Blood is a big business. The sale of its components to hospitals and other medical facilities is worth hundreds of millions of dollars around the country – a fact that rankles some.

“People say blood is free, why does it cost so much?” said Sandy Moreau, laboratory director at Elliot Hospital in Manchester. Aside from buying and storing blood products for its own needs, Elliot is the area’s overstock hospital, meaning that it keeps extra on hand to be available for other hospitals, saving an emergency trip down to Dedham. There are also overstock hospitals in Littleton and Portsmouth.

“People do graciously donate their blood. It is free, but there’s a lot of testing and processing to ensure blood is as safe as it can be,” Moreau said. “That’s expensive.”

Alice Cashin, supervisor of Elliot’s blood bank, added: “It’s a very tightly regulated field by the (Food and Drug Administration). It’s looked at almost as medication – a lot of regulation that ensures patients stay safe.”

In parts of the U.S. the blood business is very competitive, but in New England the only large-scale collection agency other than the Red Cross is the Rhode Island Blood Bank, which doesn’t run any collections in New Hampshire.

About 100 people work in the manufacturing sector at the Dedham facility, Roberts said.

Keeping track is hard, and important

Manufacturing blood products starts with intake – hundreds of boxes that get driven to Dedham from collections throughout New England. On average, Roberts said, about 1,200 donations arrive five days a week, although it fluctuates a bit.

“Winter is heavier. We’re collecting from a lot of universities. There’s the Dunkin’ Donuts drive in January. It gets lighter in summer but there’s a push to collect the same amount that we collect in the winter, to be consistent,” he said.

At any distribution and manufacturing center, keeping track of things as they move through the system is important, but it’s doubly important here since a mislabeled blood product – one that is called type B but is actually type A, for example – can harm or kill a patient. It’s also important to keep track of which separate products, such as red blood cells and plasma, came from which donor so that if a problem is found in one product, other products from that same batch can be detected.

Keeping track continues after all blood products are sent to hospitals and even long after they’re used in patients, in case something goes wrong. An extreme example known as a retrospective look-back crops up perhaps once a year at Elliot Hospital, said Moreau.

In that scenario, a donor’s blood passed all the tests at the lab and was used, but the next time that person donated, a problem was detected in their blood. The new donation will be discarded, but patients who received any blood product from the earlier donation will be alerted as a precaution, even though that earlier donation passed all the tests.

During the tour, Roberts pointed out the variety of systems by which blood products are identified, ranging from a host of computer-readable labels to a color coding system that lets him see at a glance whether products have been stored too long.

3,500 rpm

The first step in manufacturing blood products is to take that bag of blood which was carried away from your arm and put it in huge centrifuges that can spin six pints at 3,500 rpm or more – a job that must be done within 8 hours of a truck arriving at the center. This separates the red blood cells from the plasma.

The bags of red blood cells are then hung from hooks in a walk-in cooler to drain through filters that remove the white blood cells – a scene that is, to be perfectly honest, kind of creepy.

The plasma is centrifuged again to separate out the platelets, and some is taken to combine five units into one to create the cryo product with its clotting factor.

There are also various specialty orders that the center fulfills for special patient needs, many of which mean little to the outsider. Like this casual aside from Roberts: “There’s a reference lab, set up for patients that have certain red cell antigens. They’ll call up and say, I need an O-pos that has a Duffy A neg screen.”

The products then await shipment in their various temperature-controlled rooms, carefully separated by the four blood types (A, B, O and AB) and whether they are Rh positive or negative, which describes a type of protein on blood cells. Rh negative is less common and the most valuable donors are those who have O-negative blood, since they are universal donors (everybody can accept type O blood) and their blood can be given to pregnant women.

Trucks head out several times a day to hospitals, which is why the center’s location alongside I-95 is valuable. It’s also close enough to Gillette Stadium, Roberts noted, that he changes his drive home when the Patriots are playing.

Shelf life isn’t long

There’s a clock ticking over your donation from the moment it leaves your veins. Despite all the processing and separation and careful handling, all blood products except frozen plasma don’t stay viable too long.

“Platelets have a shelf life of 5 days, but the time we get them they generally have 2 to 3 days left. If we get three days with platelets, we’re thinking, ‘yahoo!’” said Cashin.

That’s why the Red Cross is constantly asking for donations, to keep supplies up, day after day. Blood supplies can’t rest on their laurels very long: even if there’s a huge surge of donations this week, more will be needed next week and the week after that and the week after that, especially since needs can fluctuate.

“If there is trauma or some of our patients who are in a hemorrhage situation, they could take 75 units of blood alone, in addition to some of the other blood products,” said Cashin.

January is national blood donation month, a designation made partly because donations tend to fade after the holidays.

Now that you know what happens to your blood after the nurse takes it way, perhaps you’ll participate.

“We’re ready for it,” said Roberts. “We’re always ready.”

(David Brooks, who has donated more than six gallons of blood in his lifetime, can be reached at 369-3313 or dbrooks@cmonitor.com or on Twitter @GraniteGeek)