One day last summer, Carlos, 40, entered the emergency room of the Ramón y Cajal hospital in Madrid with a ruptured aorta. The operation to which he immediately underwent lasted more than eleven hours, in which they had to transfuse him with fourteen bags of red blood cells, plus others of platelets and plasma. On Saturday 16 September he had to undergo a new surgery derived from the previous one because he had a fissure in the replaced aorta. In this much simpler operation, solo he needed six bags of blood. “Without that blood he wouldn’t have been saved,” he assures us emphatically the cardiac surgeon Tomasa Centella, who performed both operations. And last Tuesday, September 20, Jose, also 40, sat on one of the armchairs of the Madrid Transfusion Center to donate part of his blood: 450 milliliters. It is not the first time that he has done so: «I started donating in 2001 or 2002 and I do it every four months», he explains, adding: «I also donated during the pandemic. The only time I couldn’t do it was the time before because when I went I had a low iron. “The reason why Jose, who is unemployed and whose previous job was as a warehouse worker, started donating and continuing to doing it all these years is very simple: “I think we have to help others”.
As a donor, 1,133,311 in 2021 according to data from the Ministry of Health, gives up part of his blood until some sick, more than 493,000 in 2021 according to the same data, receives it, the blood makes an extraordinary journey in which its components are separated and, above all, follows a path that ensures its suitability and safety . In this matter, as in the rest of the sanitation services, the competences are held by the autonomous communities. Each of them has a blood transfusion center that carries out the whole process. Wherever it is donated, all the blood obtained by citizens goes to these centers on the same day it is obtained.
The blood journey begins when a person who has decided to donate a part of their body to help others goes to a donation center. “There they have a medical interview in which they make sure they meet the requirements to donate and perform a quick hemoglobin test to see if the red blood cells are okay,” explains Luisa Barea, director of the Community Transfusion Center. Madrid. To donate you must be between 18 and 65 years old, 60 in the case of the first donation; weigh more than 50 pounds; does not have or has had diseases such as AIDS, hepatitis C or syphilis and has not recently been in some countries where certain diseases such as Chagas, malaria or West Nile virus are endemic.
If everything is correct according to those parameters, they will first take several tubes of blood, with which some of the safety tests will be carried out, and a 450 milliliter bag in a process that takes ten to fifteen minutes. Once extracted, and while the donor recovers, generally with a drink or water and a sandwich, that extracted blood is placed on a butanediol plate to cool it: “When the blood leaves our body it is at the same temperature”, explains Luisa Barea, “which is about 37 ° C, and we have to lower it to 22 ° C”. Reached these 22 ° C it can be kept until it is transferred, in approved polystyrene boxes, to the transfusion center.
The figures are not the same in all autonomous communities, but Madrid, for example, receives around 900 grants per day to be processed. And it is that in some communities much more is given than in others: from the highest figures which, in 2021, were those of Extremadura with 48.30 donations per thousand inhabitants and those of Castilla y León with 45.48, to those of lowest, also in 2021, were recorded in La Rioja with 31.06 and Canary Islands with 29.63.
Once the bags and tubes arrive at the transfusion center, the procedure begins which will leave the blood ready to be sent to the hospitals that will transfuse it. That blood needs a process of separating the components: red blood cells, platelets and plasma. Because the blood is not transfused while it is being drawn. The people who will receive it do not always need all the components and, moreover, each of them has a different duration and storage needs.
The blood bags are placed in centrifuges which, with their movement, separate the three components, different in composition and weight, into layers. Subsequently, these bags are inserted into machines which, yes, introduce each of the components into their respective smaller, sealed plastic containers. Plasma cells are stored at -40 ° C, red blood cells at 4 ° C and platelets at 22 ° C, but they are not yet ready. The validation process is missing.
While all this happens with the 450-milliliter blood bags, the tubes in which even small blood samples from the same donor were collected are found in the laboratories of the transfusion center, subjected to various tests. The first thing that is checked is the blood group: «A double analysis is carried out which must coincide», explains Luisa Barea. “And furthermore, if the donor has made previous donations, it is also verified that it matches the group of those other donations. And in the event of a discrepancy, the stock market is frozen ”.
Simultaneously with the blood group investigation, a test is performed to detect antibodies to certain viruses: HIV, which is the cause of AIDS, hepatitis C and B, and syphilis bacteria. If antibodies are found, it would mean that the person who donated that blood had one of these diseases at some point. In addition to looking for antibodies, the donated blood undergoes another test to detect the viruses or bacteria themselves. “Absolutely all donated blood passes these tests,” Barea explains. “And those of those people who have been to places the previous year where some diseases are endemic are also being tested for Chagas, malaria and the HTLV virus, a retrovirus that causes certain diseases like leukemia,” she adds. .
Once all of these tests have been completed, another test is performed on the red blood cell bag to determine the blood group. Then, the validation process is performed, which is a check that all results are correct and that the blood can be transfused. The envelopes of the various components with labels with the relative barcodes with all the information are stored ready to be sent to hospitals. Those of plasma, at -40 ° C, last three years in storage; those of red blood cells, at 4 ° C, 42 days, and those of platelets, at 22 ° C, only between five and seven days. The blood journey ends in the hospital where each bag is subjected to blood group testing and compatibility studies between donor and recipient.