By Jessica Shugart
Photography by Erin Kunkel
Brennah Payne’s desperate need for blood arose the instant a semi-truck crashed into her parents’ car. She was 7 at the time. Now 14, she has vague memories of being helicoptered to Lucile Packard Children’s Hospital, where she went through nine major surgeries and 22 other medical procedures over the next six months to correct the damage done.
The impact broke her spine in half, fractured her face in 14 places, ruptured her bowels, bruised a kidney and triggered massive internal bleeding. She received countless units of blood throughout the struggle to survive.
“I remember tubes coming into me, but I don’t really remember what was in them,” she explains. “Now I know that the things that were in them kept me alive.”
Today, Brennah is a healthy teenager and a top runner on her school’s cross-country team. Although she has recovered from the accident that occurred half a lifetime ago, she has never forgotten how the generosity of blood donors saved her life.
“There were so many people helping me, and I didn’t really know why,” she says. “I just knew that I felt love from them, and it made me happy because without them I wouldn’t be here today.”
Her mother, Heather Payne, a nurse, recalls her newfound appreciation of blood donors after her daughter’s accident. Before, she says, “I wasn’t so tuned in with the importance of blood donation. It was always so easy to just go and get a unit of blood from the lab and give it to a patient. Afterward, it was really eye-opening to me to consider that concept of people not knowing who they’re giving it to.”
Brennah is a champion for blood donation these days, speaking at donor appreciation events and blood drives. “It’s almost like you can be a superhero,” she says, “if you just donate an hour of your time to give blood.”
Most donors give blood only a few times a year, if that. But for Linda Johnson, it’s a routine part of life. On this fall day in 2012, Johnson reclines in a comfy chair at the Stanford Blood Center, wrapped in a soft, powder-blue blanket, while two pints of blood drain from a vein in her arm. Right next to her, a machine snatches the tiny cell fragments called platelets from her blood and returns the rest of the fluid back into her vein. She’s a very familiar face here: This is her 561st donation.
Though Johnson has been donating at the Stanford Blood Center for 25 years, her history of giving blood starts even earlier. She donated in college and — like many who give of themselves to help others — found the experience rewarding. Wanting to make a bigger impact, she got tested to see if she’d be eligible to donate platelets, a blood component crucial for clotting. Because only platelets are removed from their blood, these donors can give more than the usual pint at a time, and can do so more often. Johnson donates twice a month, whereas whole-blood donors are limited to once every eight weeks.
“I donate because I can. My fortune is good health,” says Johnson. “I know many people who are not healthy, and there is no substitute for blood.”
Johnson, the only woman to surpass 500 donations at the Stanford center, admits she’s also in the game for a little friendly competition with her fellow donors: At her current pace, she’ll hit 600 donations in June 2014.
“I get the satisfaction of knowing I helped save somebody’s life, and I’ve done that more than 500 times,” Johnson says. “It’s extremely heartwarming. Plus I get cookies — at least two.”
Each of us has about 10 pints of nature’s life-giving concoction flowing through our arteries and veins — delivering oxygen to vital organs, fighting infection and healing wounds. In spite of striking advances in our understanding of how blood works, no one has come up with a substitute that re-creates all its virtues. To date, the only replacement for lost or damaged blood comes in the form of a gift from a willing donor, which is why donors are vital.
"It’s almost like you can be a superhero if you just donate an hour of your time to give blood."
On the surface, the concept of blood transfusion seems simple (and perhaps a touch unnerving): One person’s bodily fluid is harvested to save the life of another. Yet the relatively safe procedure we use today came only after centuries of experimentation — a story rife with both life-saving triumphs and fatal disasters.
Two dogs served as the conduit for the first of a flurry of transfusion experiments that took place in the 17th century. Using a goose quill for a needle, English physician Richard Lower transferred blood from a mastiff to a medium-sized dog in 1665. Since he had drained the blood of the medium-sized dog beforehand, the transfusion effectively saved its life.
Just two years later, French physician Jean Baptiste Denis made the jump to humans. He transfused 9 ounces of sheep’s blood into a teenage boy by attaching the animal’s carotid artery to the boy’s arm. The boy survived the ordeal, prompting Denis to perform the procedure on several other patients until, eventually, one died. The death triggered a backlash against blood transfusion, leading several countries to ban it. By 1668, the experiment of transfusion had been put to rest as quickly as it had arisen.
It was another 150 years before the first recorded blood transfusion between two humans took place. In 1818, British physiologist James Blundell combined blood from several donors and injected the mixture into a patient suffering from internal bleeding. Though the patient initially improved, he died three days later. The cause of the delayed fatal reaction wouldn’t be understood until the next century.
Blood transfusion remained hit-or-miss for the rest of the 19th century — saving lives in some cases and leading to death in others. Then, in 1901 Austrian physician Karl Landsteiner discovered the existence of different “blood groups.” Landsteiner found three groups — A, B and O — that contained one (A or B) or neither (O) of two antigens on the surface of red blood cells. Importantly, he found that people receiving mismatched transfusions made destructive antibodies against the blood-borne antigens that weren’t theirs. For example, people with type-A blood produced antibodies against type-B blood, and vice versa. The antibodies latched onto the donor blood and caused the red cells to clump, leading to the fatal reaction that explained the variable success of blood transfusions up to that point. A simple cross-matching test was soon developed to check the compatibility of blood samples prior to transfusion. In 1902, the fourth blood type, which carries both antigens, was discovered and named AB.
The final hurdle blocking efficient transfusion would be blood storage. Scientists broke this barrier in 1916 with a sodium citrate solution that prevented donated blood from clotting, allowing for storage over several weeks. Drawing from these discoveries, U.S. Army physician Oswald Robertson opened the first blood bank in 1917 in a military hospital in war-torn France. He stocked the shelves with type-O blood — considered the “universal donor” because of its lack of both A and B antigens.
War continued to drive the advancement of blood distribution and storage in the following decades. By the late 1940s blood banks were springing up throughout the United States. After the urgency of World War II subsided, blood-banking challenges shifted to the development of tests for infectious diseases transmitted through blood transfusion. (By that time, researchers had also discovered another aspect of blood type: the presence or absence of the Rh protein, which got its name from rhesus, the animal in which it was discovered.)
Today, a sample from every batch of donated blood undergoes a barrage of tests to ensure its safety. In a process tightly regulated by the U.S. Food and Drug Administration, each unit of donated blood is screened for HIV, hepatitis B, hepatitis C, human T-lymphotropic virus, syphilis and West Nile virus. All donors also get a one-time screening for Chagas disease. And at Stanford’s center, unlike most other blood banks, every unit is screened for cytomegalovirus, a member of the herpes virus family that’s harmless for most healthy people but dangerous for transplant recipients and other immunosuppressed patients — who make up a large portion of transfusion recipients at Stanford.
Historically, Stanford Blood Center has been ahead of the game in screening for infectious disease. In 1983, for instance, when it became clear that AIDS was spreading to transfusion recipients through donated blood, Stanford was the first center in the world to screen for the mysterious infection, using an indirect test the blood center’s director developed. The center was also the first to routinely screen for cytomegalovirus, which is carried by half the nation’s population.
For Jan Webster, supervisor of the blood center’s testing lab, adhering to the many rules and regulations of blood banking is actually rather enjoyable. “I guess I’m a weird duck, because I really like the regulation part, that part of keeping your ship tight,” says Webster, a medical technologist and educator who came out of retirement to perform donor testing.
From the discovery of blood types to the continuing development of tests for new infectious diseases, the past century of blood transfusion research has focused on rooting out the dangers lurking within an otherwise lifesaving product. But all of these dangers could be eliminated if researchers came up with a workable blood substitute. Imagine it: no blood types to worry about, no infectious diseases to transmit.
Several biotech companies have taken a stab at manufacturing an artificial alternative to blood — with frustrating results. In 2006, for instance, Northfield Labs concluded a controlled clinical trial in which trauma patients were infused with either natural blood or a substitute called PolyHeme, designed to replicate the oxygen-carrying capacity of red blood cells. Unfortunately, trauma patients receiving the PolyHeme infusions turned out to be slightly more likely to die of their injuries compared with patients infused with real blood (13.2 percent versus 10 percent). Northfield, which had spent 20 years trying to make a successful blood substitute, closed its doors in 2009.
If blood substitutes are ever to stand in for donor blood, they’ll need to fulfill a host of other requirements before they’ll measure up to the real thing. In addition to transporting oxygen throughout the body, blood contains platelets and clotting factors that stop internal bleeding, white blood cells that fight infection, electrolytes needed for organ and muscle function, and myriad vital proteins — some poorly understood and others yet to be discovered.
When it comes to blood, so far nature knows best.
Because of its many complex functions, whole blood is commonly separated into three “blood products” after collection: red blood cells, platelets and plasma. That means one donor’s gift of blood has the potential to save up to three lives.
"I guess I’m a weird duck, because I really like the regulation part, that part of keeping your ship tight."
Red blood cells are oxygen-delivery specialists; without them, breathing would be pointless. They pick up oxygen in the lungs and drop it off at organs around the body, constantly returning to the lung for refills.
Red blood cells are the most common type of transfusion. While gravity alone is enough to separate them from the rest of the blood, a gentle centrifuge is used at blood centers to hurry things along. The concentrated red cells — commonly known as “packed” red blood cells — lend their oxygen-carrying capacity to trauma victims, anemic patients and cancer patients. The cells, which have a shelf life of 35 to 42 days depending on how they’re preserved, save lives by keeping vital organs functioning.
Platelets perform the crucial task of patching potential blood leaks through clotting. Not exactly cells in their own right, platelets bud off of other blood cells called megakaryocytes. The fragile cell fragments live only five to nine days — plugging leaks by forming blood clots. They decline even more rapidly in response to harsh cancer treatments like chemotherapy or radiation, so cancer patients often need platelet transfusions to prevent them from bleeding profusely from even minor wounds.
While platelets can be separated from whole blood, it takes about five whole-blood donations to glean one effective dose of the platelets. That’s why donors like Johnson donate platelets specifically instead, through a process called apheresis. A machine next to the donor’s chair harvests only the platelets (along with some plasma) and returns the rest of the blood to the donor through the same needle. Because the majority of red cells are returned to the donor, platelet donors can also donate more frequently than whole-blood donors — often, once every two weeks rather than once every eight.
Plasma, the clear, yellowish liquid component of blood, makes up 55 percent of blood volume. Free of all cells and platelets, plasma is 93 percent water and 7 percent vital proteins. Plasma proteins help clot blood, fight infection and prevent shock. As such, plasma may be transfused into people with clotting disorders, patients fighting infectious diseases such as hepatitis, or trauma victims experiencing massive fluid loss.
Donors in the United States gave 17 million units of blood in 2008, 70 percent of which came from repeat donors rather than first-timers. While an estimated 37 percent of Americans are eligible to give blood, only 10 percent actually have. Worldwide, transfusions are needed to replace blood lost in traumatic injuries or from hemorrhaging during childbirth. However, in developed countries like the United States, the majority of donor blood is now used during planned surgeries or to replace the treatment-ravaged blood of cancer patients.
In addition to collecting blood from people who come in to donate, Stanford Blood Center hosts mobile blood drives at local high schools, workplaces, churches and community centers. The blood is collected onsite and then wheeled back to the center for processing and testing. In this way, the center reaches people who might never have thought to donate.
The center, created in 1978 within the School of Medicine, supplies blood products not only for transfusion but also for research. As the primary supplier of blood to Stanford Hospital & Clinics, Lucile Packard Children’s Hospital and other local medical facilities, it produces about 100,000 individual portions of blood products for transfusion each year. The center also plays a special role in the research community: With donors’ permission, leftover fractions, which at other blood centers are routinely discarded, go to labs studying human health and disease. In 2011, the center produced more than 54,000 samples of blood products for research.
Robert Henslin is intimately aware of the lifesaving qualities of every blood product. At the age of 26, just six months after getting married, he was diagnosed with acute lymphoblastic leukemia. The following year and a half of intense chemotherapy and radiation ravaged his blood.
“There were blood transfusions needed all along,” says Henslin. “I was getting platelets, whole blood, red cells, basically the whole shooting match just so I could benefit from the cancer treatment and stay alive.”
Henslin enjoyed a 20-year remission, highlighted by the birth of two daughters, before the cancer returned. This time, his doctors told him his only real shot at survival was a bone marrow transplant.
Henslin went through months of chemotherapy before the bone marrow transplant he ultimately received. Once again, the treatment decimated not only the cancer cells but also the red blood cells, platelets and white blood cells that he needed to stay alive.
He recalls one instance when his platelets were so low that his blood failed to clot. Blood was leaking out of the I.V. site in his arm just as fast as blood products were being transfused in. “They were changing the bandage every 20 minutes,” Henslin says.
Multiple transfusions of platelets — which Henslin describes as looking like apricot nectar — allowed his blood to clot again.
Eventually four good genetic matches were found for Henslin, the best of which was on the other side of the world: a young man in Germany, who had initially signed up with the bone marrow registry in the hope of saving a teacher who had fallen ill. The young man’s bone marrow was shipped to the United States and transfused into Henslin’s irradiated body at Stanford Hospital’s E1 Transplant Unit.
Throughout his recovery from what doctors called a “difficult” transplant, Henslin required countless additional transfusions.
“Every time I received a bag, I thought, ‘Somebody gave this up for me,’” says Henslin. “I never took it for granted.”
That was four years ago, and though Henslin still suffers from after-effects of the transplant, according to his doctor, he will probably never have to worry about leukemia again. He feels extremely grateful not only to the bone marrow donor, but also to the blood donors who kept him alive throughout his treatment.
“Anything you can do to step out of yourself, out of your comfort zone, do it. The benefits are phenomenal,” says Henslin. “You get to help a fellow human being, and you’ll feel like you spent part of your day doing something really, really important.”
Just what motivates these blood donors that Brennah calls “superheroes”? Some of Linda Johnson’s reasons are surprisingly down-to-earth.
She and other Stanford blood donors have online access to individual accounts that track the number of donations they give each year. Fueled by the knowledge of her own stats and by conversations with fellow donors, Johnson’s competitive drive causes her to donate platelets the maximum amount of times — 24 — per year. “It’s a little game we play. And I’m very good at it,” she says.
But even more than the friendly competition, Johnson and others donate because of the lives they know they’re saving.
“Every once in a while when the needle is uncomfortable, I think about the folks who are getting blood transfusions, especially little kids, and how much discomfort they are in,” says Johnson. “That usually puts things in perspective for me.”
Every year the blood center hosts a “Precious Mettle” breakfast honoring donors who have given blood more than 100 times. Several transfusion recipients are invited to speak. Johnson chokes up when she recalls the mother of a 3-year-old girl who thanked the donors for saving her daughter’s life.
Some consider blood donation a selfless act. Yet it seems that the experience of saving a life, of being part of a donor community, of giving in general, also fulfills a very human need on the part of the donor. Just like an apheresis machine that returns fluid to the donor as they give, the benefits of blood donation are not a one-way street.
For 35 years, thousands of hospital patients in the Palo Alto area have directly benefited from the blood provided through the Stanford Blood Center. But because of its research activities, the center also affects the lives of people throughout the world.