One in three Australians will rely on blood donation at some point in their lifetime. With a shortfall of donors to meet the high demand, it is hoped recent eligibility changes will turn that around.
By Kathy Skantzos
Despite efforts to minimise the use of blood transfusions in surgery, donor blood is always needed by more than a million patients each year.
Over 33,000 blood donations are needed every week in Australia to meet the clinical demand for blood – that is a requirement of more than 1.7 million donations. In WA, it means more than 3500 blood donations a week.
Dr James Daly, Medical Director of Pathology Services at the Australian Red Cross Blood Service, told Medical Forum there is a critical need for more people to donate blood – and now with recent eligibility changes, more can.
One blood donation can save up to three lives – helping patients with cancer, anaemia, trauma-related injuries, kidney disease, those undergoing surgery, pregnant women and new mothers, and patients with chronic conditions requiring blood transfusions.
“We all know somebody who has needed a transfusion or blood-derived treatment at some point,” he said. “At the moment only one in 30 Australians donate blood, while that’s still half a million active donors, there are many more Australians who would be eligible to donate.”
Donor eligibility rules are based on medical and scientific evidence and are continuously revised. Restrictions for blood donation have changed for people with tattoos and people at risk of being exposed to sexually transmitted diseases such as HIV, for example.
“We’ve recently had some big changes to some of our long-standing deferrals, and finetuning some of the deferrals for COVID,” Dr Daly said.
Bans lifted
Notably, the two-decade blood donation ban for anyone who lived in the UK between 1980 and 1996 for six months or more during the mad cow disease outbreak was lifted in July 2022. The ban was a precautionary measure put in place in December 2000 in response to concerns about the risk of human variant Creutzfeldt-Jakob Disease (vCJD).
When the Therapeutic Goods Administration lifted the ban, after Lifeblood’s medical experts worked with the University of New South Wales’ Kirby Institute to research the risk of vCJD in Australia’s blood donor population, the Red Cross has since welcomed an extra 60,000 donations from this group.
The change has been especially well received in WA.
“Up to 17% of our donor attendances have been from that group of previously deferred donors. It’s been more than we anticipated in terms of the uptake of donations from that group,” Dr Daly said.
Restrictions for blood donors with tattoos has also changed, with recent large-scale clinical research showing there have been no infections from their plasma donations.
“Looking at the data from the past two years of plasma donation (when the ban was lifted for those who had a tattoo from a licensed parlour in Australia), there have been no tattoo-related infections identified in 20,000 donors who’ve donated plasma upfront,” Dr Daly said.
Blood components prepared by Lifeblood include red cells, platelets, fresh frozen plasma, cryodepleted plasma and cryoprecipitate. There are a growing number of patients relying on plasma donations for the treatment of cancer, immune disorders, haemophilia, trauma and kidney disease – making plasma donations just as important as other forms of blood donation.
People with new tattoos can donate plasma immediately after getting a new tattoo, however they still needed to wait four months to give blood, red cells or platelets, but Dr Daly said this could also change.
“We do think we could remove that deferral for the fresh components as well, and we’ll be submitting to TGA shortly about that,” he said.
COVID impact
The Red Cross experienced a huge drop in the number of blood donations due to COVID-19, partly due to the time donors had to wait after recovering from the virus. Up until early 2022, blood donors were required to wait 28 days after being exposed to the virus before being eligible to donate.
Now, with more scientific knowledge about the virus and most of the population having had exposure to it and having been vaccinated, the restriction for donating blood after a COVID case has now been lifted to seven days after recovery.
Dr Daly said that donors are asked to wait three days after a COVID vaccination before donating blood, plasma or platelets.
Minimising HIV risk
One of the most contentious deferrals is for sexual activity, including people at a higher risk of exposure to HIV. Sexually active people in groups with a statistically higher risk of HIV infection cannot donate – unless they allow a window where there is no sexual activity.
“Our present policy is that anyone who’s at higher risk of exposure to a new HIV infection must wait three months since their last high-risk sexual activity before they can donate blood,” Dr Daly said.
Australia currently has one of the lowest risks in the world of being infected with HIV through a blood transfusion.
“There was a change in 2021 when we reduced that deferral from 12 months to three months since their last sexual contact. We’re actively considering if we can completely remove that rule for plasma donation, similar to the tattoo deferral,” Dr Daly said.
If this change is approved, Australia will be the first country in the world to implement this plasma pathway.
Blood management
The National Blood Authority is active in promoting patient blood management, with a series of guidelines reflecting a systematic review of the scientific literature and clinical expert consensus. These cover six different settings – clinical bleeding, perioperative, medical, critical care, obstetrics and maternity, neonatal and paediatrics.
There has been a shift towards defining the most appropriate use of blood products to ensure they are used only in situations where clinicians know patients are going to benefit from them, which includes the correct use of blood transfusions.
“It is important for us to recognise that blood is a precious and limited therapeutic product, donated by the goodwill of blood donors and we should respect that, use it appropriately and make sure we don’t waste it and use it for patients who need it,” Dr Daly said.
“Taking that principal along with the emerging evidence that transfusion isn’t always in the best interest of patients, this movement of patient blood management has emerged.”
The landmark TRICC study in 1999 is one of the earliest examples that supports the use of a restrictive transfusion strategy for ICU patients, targeting haemoglobin of 70 g/L.
“We’ve had some good clinical trials that show transfusion may not improve patient outcomes and may in fact be detrimental,” Dr Daly said.
“Rather than transfusing patients when haemoglobin dropped to 90 g/L, they compared that with waiting a bit longer until haemoglobin dropped to 70 g/L and there was no difference in outcomes. There were no benefits from transfusing patients more liberally – in fact restrictive transfusion of patients was probably more beneficial.”
Since then, many other studies have looked at restrictive transfusion practices with red cells and with platelets to define when it is appropriate to give blood.
“The aim is to improve patient outcomes by optimising and conserving their own blood – minimising blood loss, avoiding unnecessary transfusions by using blood products and non-blood alternatives to treatments appropriately and based on evidence that patients are going to benefit from it,” Dr Daly said.
GPs’ role
Dr Daly said GPs played a critical role in identifying anaemia or iron deficiency in patients. This was particularly important for avoiding adverse outcomes for patients undergoing elective surgery where there was a potential risk of blood loss and an increased chance of blood transfusion, as outlined in the National Blood Authority’s perioperative patient blood management guide.
“GPs preparing their patients for elective surgery also need to flag with the surgical team if their patients are on medications that might increase their risk of bleeding, such as anticoagulants or anti-platelet medications, and more broadly if patients have antibodies to particular blood groups or if they have a rare blood type or special transfusion requirements,” Dr Daly said.
The state-wide antibody register, which is unique to WA, enables any patient who has had a red-cell antibody identified in any labs to have this information listed on the register, with their consent.
More donors
There are some medical conditions and other exclusions that restrict patients’ eligibility for blood donation – but common medical conditions and medications such as antihypertensive medications are not necessarily exclusions.
People with type 1 diabetes, for example, require the approval of their treating doctor or a medical officer to give blood, on the proviso that their blood sugar levels are well controlled and they have no active complications such as eye, heart, blood vessel or kidney problems.
“We have many donor eligibility rules, which are designed to help donors’ wellbeing as well as that of the recipient,” Dr Daly explained.
People carrying in-demand blood, such as cases of genetic haemochromatosis, or iron overload, should be encouraged to become blood donors if they are eligible. Giving blood helps these donors offload some of their iron, while their iron-rich blood is useful for patients with anaemia.
Lifeblood is eager to identify donors who have developed an antibody to the RhD blood group, known as anti-D.
“We need those donors to make a very special product called RhD immunoglobulin – used for pregnant women who are D-negative to prevent their babies being affected by haemolytic disease of the newborn, or erythroblastosis fetalis” Dr Daly said.
“We are very keen for donors who have anti-D to contact Lifeblood,” Dr Daly said.
With a strong demand for blood donation, Dr Daly encourages doctors to refer patients between 18 and 75 to Lifeblood to find out if they’re eligible to donate blood.
“The demand is always there,” he says.