A pint of O neg, stat!
There is a liquid that surpasses every medicine in terms of its lifesaving qualities: blood. Hundreds of thousands of people receive a transfusion each year and pharmacy staff have a role in raising awareness of the importance of donating
There are many reasons why someone might need a blood transfusion: an emergency situation such as a serious traffic accident, for a medical condition such as anaemia or sickle cell disease, or as a consequence of surgery or medical treatment such as chemotherapy. There is always a demand for blood, and hence a need for donors – in England alone, over 200,000 new donors are needed each year to replace those who stop donating.
Lynne Moulder, senior campaign lead for marketing at NHS Blood and Transplant (NHSBT), says that frontline healthcare staff are well placed to raise awareness. Much as patients can sign up to become blood donors when they register at a GP surgery, pharmacies are visited by many people on a frequently basis – though Lynne sounds a note of caution that it isn’t a topic that is suitable for everyone, particularly if they are unwell. However, she says: “Pharmacy staff often have a good rapport with the people who come in, so can bring up the topic conversationally. For example, if someone has a close relative who is undergoing treatment for cancer and friends and family want to do something to help, consider mentioning that many patients need blood transfusions.”
Lynne continues: “Blood is always needed in the NHS. Hospitals have become much more efficient and clinical practice improves so much every year that the overall demand is falling, but the increasingly diverse population means that the mix of blood types that are required is changing.”
New donors are always welcome, Lynne states, but she highlights O-, A- and B- as priority blood groups, as well as people of black ethnicity who are more likely to be matches for those with sickle cell anaemia – a disorder more common in black communities – many of whom require regular transfusions.
In 2014, two-thirds of donated blood was used to treat medical conditions such as cancer and anaemia
Spread the word
There’s no real science behind what encourages people to sign up as donors. An episode of the BBC television series Call The Midwife that featured a family afflicted with sickle cell disease resulted in 46 per cent more people registering online with NHSBT than had in the same hour on the previous day, is a case in point. But Lynne says a good place for pharmacies to start is displaying leaflets and posters. She explains: “There are lots of materials available – [many] that can be edited to make them specific to your location – including digital resources that can be added to websites highlighting where the nearest donation centre is.”
Many people worry that they can’t give blood but if someone is generally fit and healthy, weighs between 7 stone 12lb and 25 stone (50-160kg), and is aged between 17 and 66 years, they may well be able to. Some of the broad exclusions are pregnant women, anyone who has had a tattoo or piercing in the last four months, someone who has travelled to a part of the world where malaria is endemic during the last year, and individuals who have had sex with a potentially high risk partner in the last three months: this includes carriers for HIV and hepatitis B and C, men who have had sex with men, anyone who has ever received money or drugs for sex, and anyone who has ever injected drugs.
Jodie Freeborn, a pharmacist who works as quality manager for the Central UK region of LloydsPharmacy, has been giving blood since she was 17 years old and is now a silver donor, meaning she has given more than 25 pints. “My dad was a blood donor and used to take me and my sister with him to the sessions. He had a road traffic accident when he was younger, so talked about it as a way of giving something back to the NHS. I started donating too when I could, and over the years have encouraged friends to do the same by taking them along with me,” she explains.
Jodie says that one way in which pharmacy staff can make a meaningful contribution is to talk to patients if they are concerned about whether any medication they are taking could preclude them from donating blood. These include finasteride; dutasteride; isotretinoin; antithyroid drugs such as carbimazole; immunosuppressants such as prednisolone and methotrexate; iron supplements; and antibiotics, unless they are long term, for example, for acne.
There are some conditions that mean an individual can’t donate, such as cancer, stroke, inflammatory bowel disease, chronic lung disease (except asthma), heart disease (except high blood pressure or cholesterol), insulin dependent diabetes, and neurological problems including multiple sclerosis and chronic fatigue syndrome. Surgery is another potential issue, with a four-month exclusion applied to anyone who has had an endoscopic procedure, and six months for major operations. Anyone who has received a blood transfusion is also not allowed to donate.
The period after donor sessions is another time during which community pharmacy teams can add value, says Jodie. “I’ve never had any problems, but there can be a little bit of bruising and bleeding afterwards around the site they take the blood from, so some advice might be needed.”
That reassurance can extend to explaining how the body has an astonishing capacity to replace all the fluid and cells that have been lost, with the white cells and platelets replenished in a matter of days, while the red blood cells take a bit longer – this is why men cannot donate any more frequently than every 12 weeks, and women need to leave a gap of at least 16 weeks.
It is also a great opportunity to celebrate the fact that the person has done something amazing. According to NHSBT, in 2014, two-thirds of donated blood was used to treat medical conditions such as cancer and anaemia, 27 per cent was used in surgery, and six per cent was used to manage blood loss after childbirth. Being part of this lifesaving and lifegiving work is something very special.
What's your type?
An individual’s blood type is determined by their genetic make up. Antigens – combinations of sugars and proteins – that coat the surface of red blood cells dictate the letter, while the presence or absence of one in particular– the Rhesus D antigen – determines whether it is positive or negative. There are eight main blood types:
- O+ is the most common blood type with over a third of donors having it. Anyone with Rhesus positive blood – that’s over three quarters of the population – can receive it, and it is the type most commonly requested by hospitals so it is always in demand. People with O+ blood can only receive O+ and O- blood.
- O- donors make up around 13 per cent of the donor population, but anyone can receive this blood – hence in emergency situations, such as those depicted on TV hospital dramas, the medics will call for “O- stat” because they haven’t had time to establish which blood type the patient is – so they are often referred to as universal donors. O- patients, however, can only receive O- blood.
- A+ is the second most common blood type in the UK, with 30 per cent of the donor population having it. It can be given to people with A+ and AB+ blood – hence almost a third of requests for blood from hospitals are for this type, and A+ platelets are the most commonly used – while someone with A+ blood can receive donations from A+, A-, O+ and O- donors.
- A- blood is what around eight per cent of donors have, and it can be given to anyone with any of the A or AB blood groups. A- platelets can be given to anyone so are called the universal platelet type. However, people with A- blood can only receive blood from A- or O- donors.
- B+ is donated by around the same proportion as A-, though group B overall is much rarer than group A. It can be given to people with B+ and AB+ blood, and is particularly important in the management of the blood disorders thalassaemia and sickle cell disease, both of which require regular transfusions, and tend to affect South Asian and black communities in which the B+ type is more common. B+ people can receive any B or
O blood types.
- B- is one of the rarest blood types, with just two per cent of the donor population having it. However, because all group B and AB people – that’s one in eight – can receive it, it is very useful, while B- individuals can only receive red blood cells from B- and O- donors.
- AB+ is as uncommon as B-, but AB+ people who need blood are universal recipients – they can safely receive red blood cells from any blood type. Because only AB+ individuals can receive AB+ blood, donations from this type are managed differently to all others: donations from men result in fresh frozen plasma, which is always needed, and female donors are only contacted when demand for AB+ rises and stocks are low. This is because women, particularly those who have been pregnant, can develop antibodies that can be life threatening to anyone who receive their plasma.
- AB- is the rarest of the blood types, though they can receive donations from anyone with Rhesus negative blood. Donors are managed in much the same way as those with AB+ blood.
Red blood cells can be stored for up to 35 days, platelets for no longer than a week, and plasma for a maximum of three years.
Find out more
Promotional materials are available from NHS Blood and Transplant
Each of the UK home countries has its own NHS organisation that coordinates blood donations and transfusions: