NEWS AND INFORMATION FOR BLOOD DONORS
WINTER 2009
Living with thalassaemia
Prove it!
Our campaign to sign up more organ donors
S Y A S Y K S IN L P A K A NATASH to give blood”
“It doesn’t take a lot to
OUR NEW NUMBER – 0300 123 23 23
In this issue COVER STORIES
4 What a gift to give
When a friend’s baby needed an emergency blood transfusion, TV presenter Natasha Kaplinsky knew she wanted to support our campaign to attract new donors
8 Just a click away
Sit back and organise your next appointment through Blood Donor Online
9 How we prepared for swine flu
A swine flu pandemic could create huge challenges for all types of services and businesses. We have made detailed plans to cope in the event of a major outbreak PAGE 4
11 Blood buddies
Even as a child, Julia Moloney-Smerdon knew she wanted to be a blood donor. What decided it was when her best friend was diagnosed with bone cancer
12 Little Jack’s miracle
Rich in stem cells, cord blood can help to cure many life-threatening diseases. For the Cooper family, it was their best hope for helping baby Jack
14 Making donating easier PAGE 15
Donors in Poole can now pop into their local Boots store to give blood. It’s all part of our drive to make donation easier and more convenient for you
15 Living with thalassaemia
In the UK, hundreds of people live with the inherited blood condition, thalassaemia. Thanks to better treatments, sufferers can still enjoy a full and active life
17 Prove it!
Over 95 per cent of the UK support organ donation, but only 27 per cent are signed up on the NHS Organ Donor Register. Our new campaign aims to change that
21 Margaret keeps on giving PAGE 17
A donor looks back on 50 years of giving blood
Write and tell us
Dr Margarita Sarishvili explains the difficulties Afghans face in accessing a reliable and safe supply of blood
your news, views and interesting or unusual donor stories.
Write to The Editor, The Donor, NBS, Colindale Avenue, London NW9 5BG or email thedonor@ nhsbt.nhs.uk
23 When a blood transfusion can be a death sentence 25 Changes for the better
Our new programme for improving donor sessions has reduced waiting times for donors and boosted our productivity
26 “After eight days, I finally woke up”
Meningitis is a killer and teenagers are especially vulnerable to the disease. Oliver Janes was lucky that doctors could save him
28 Good operating standards
Surgeon Jordi Sanchez-Ballester talks about the importance of blood transfusions in surgery Plus our regular News, Letters, Q&A, Ask the doctor and Crossword
The cost of producing, printing and posting each copy of this magazine is less than the price of a second class stamp. The Donor is published by the National Blood Service (NBS) which is part of NHS Blood and Transplant (NHSBT). Reproduction in whole or part is strictly forbidden without the prior permission of NHSBT. Larger print versions are available via the website. Design and production: Ant Creative (London). Reproduction: Portland Media (London). Printed by The Stationery Office on 100% recycled paper.
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COVER STORY
What a gift to give Why did you decide to join our summer campaign ‘Don’t Wait to Donate and Bring Your Mate’? A very dear friend of mine’s fivemonth-old son recently had a large operation. It was a success but he later haemorrhaged and the surgeons could not stop the bleeding. If it wasn’t for the surgeon’s skill and the blood bank, his life would not have been saved. That doesn’t bear thinking about. I can’t believe it has taken something so serious for those of us who vow to become regular blood donors to do so.
When a friend’s baby needed an emergency blood transfusion, TV presenter Natasha Kaplinsky knew she wanted to support our campaign to attract new donors
What would you like to say to blood donors that have helped save a life?
What do you think has been on every bit of strength you have. Natasha in the Five News studio your biggest achievement in Was taking part in Strictly at Channel Five life so far? Come Dancing as much fun as Being a mother! There is nothing it looked? I have ever had. It is such a great show
Thank you and I respect you. While it doesn’t take a lot of effort to give blood, it does require each donor to be empathetic and selfless. To give blood is to help save a life and there can be no greater gift.
like trying to placate a crying baby Strictly was fantastic, but it was the and I feel very proud to have won the in the middle of the night that draws most nerve-wracking experience that first ever glitter ball but the standard is so high now, I doubt I would make it past the first week.
LIFE STORY
Have any of your family needed blood? Luckily no, but you never know when someone you love will need donated blood. And frankly, even if it is a perfect stranger, what a gift to give.
Ultimately, you could be helping to save someone’s life.
Natasha came along to a donor session as part of the ‘Don’t You’re a successful journalist. Wait to Donate and Bring Your Will you try to become a How did you get started? Mate’ campaign regular donor and will you I had always wanted to work as a be encouraging family and journalist but I didn’t know how The story behind my family was friends to donate? I could break into such a tough very painful and caused us all a lot I have given blood in the past but I am ashamed to say that I am not a regular donor. I will be now though and will be dragging everyone I know along with me. It is such a painless process, and takes very little of your time.
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industry. It was through hard work, determination and having a thick skin that I have made any headway!
What was it like appearing in Who Do You Think You Are? It was an amazing experience.
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of heartache and many tears, but unearthing our history was also a fantastic and very educational experience. History is so much more easily approached through intimate stories. The series is genius.
l Born 9 September 1972 in Brighton, Su ssex l 1995 – graduated from Hertford Colle ge, Oxford University l 1996 – started broadcasting career w ith LWT’s Talk TV then moved to news prese nter role at Meridian l 1999 – moved to ITV’s London News Network to host London Today, London Tonight and political show, Seven Days l 2000 – presenter for Sky News’ breakf ast news programme, Sunrise, and co-presenter of Live at Five, with Jere my Thompson l 2002 – presenter at BBC for Breakfast , then News at One, Six and 10 O’Clock News l 2008 – moved to Channel Five to pres ent Five News l
Your job is clearly demanding. Do you have time for any hobbies? My husband, Justin, and I have two fantastic Tibetan Terriers called Molly and Benson and when I am not working, looking after the baby and sorting out everything else that needs to be done to keep our life running to plan, Molly and Benson are my greatest indulgence. They are very sweet-natured and love nothing more than to be pampered and walked. Sadly, they don’t get much of a look in with a one-year- old baby in the house but they are very special. l WINTER 2009 THE DONOR
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ews Update • News Update • News Update • News Update • News Update • News Update • News Update • News Update • News Update • News Update
A lifesaving legacy
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World’s largest blood centre opens O
ctober saw the official opening of Filton by one of the world’s leading heart transplant surgeons. Professor Sir Magdi Yacoub unveiled a plaque watched by NHSBT staff including chief executive Lynda Hamlyn and chairman Bill Fullagar (pictured above). Recipients and donors also came to speak about their experiences and enjoy lunch. Professor Sir Magdi Yacoub had the opportunity to meet staff during a tour of the centre’s manufacturing halls and laboratories. The £60 million facility is the largest blood manufacturing centre in the world, processing and testing up to 600,000 units of blood a year. The Filton NHSBT centre is also home to the British Bone Marrow Registry, the British Institute of Transfusion Science and more recently the NHS Cord Blood Bank. l
Modernisation for West End centre
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ur flagship West End donor centre in central London is being modernised. The centre attracts thousands of blood donors working in London, and has had many high-profile visitors. NHSBT’s Anthony Dorman says, “The new-look donor centre will offer a greatlyimproved environment for donors and help to reduce waiting times. There will be an increase in the number of screening booths and
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changes to the floor plan to improve donor ‘flow’. The space will be made lighter and airier with improved visibility throughout.” While the three-month project is taking place, the 17 session staff will operate from a bloodmobile parked in nearby Berners Street, just outside the Oxford Street Plaza shopping centre. It is hoped the new-look centre will re-open on Monday, 25th January 2010. l
THE DONOR WINTER 2009
dying journalist’s wish to save lives by educating young people about donation looks set to go nationwide after a successful pilot project. Leukaemia sufferer Adrian Sudbury, 27, from Sheffield, worked for the Huddersfield Examiner and wrote an online diary, ‘Baldy’s Blog,’ chronicling his treatment which attracted worldwide attention. Despite a bone marrow transplant, Adrian sadly died in August 2008. He spent his final
months campaigning to raise awareness of blood, bone marrow and organ donation. Before he died, Adrian met Gordon Brown and the Education and Health Secretaries. In November 2008 the Government pledged £40,000 for a pilot education project. This was matched with £40,000 in private funding. The ‘Register & Be a Lifesaver’ project was trialled in Bristol and South Yorkshire. We worked with the Anthony Nolan trust to train volunteers to give talks to students about donation. These volunteers, known as ‘Adrian’s Army’, have already given presentations. In September 2009, Schools Secretary Ed Balls announced that Government money would be made available to allow the project to be rolled out nationally. l
Back in the action A
fter over a year out of action with a knee injury, Manchester United goalkeeper Ben Foster has returned to Premier League football thanks to a tissue donor. Ben ruptured his cruciate ligament in 2007 and had an operation to repair it. But when he suffered the same injury again, his surgeon decided the best way to mend the potentially career-ending damage was to transplant a tendon from a deceased donor. Ben needed a year out of the game, including six months rehabilitation to help the tendon to heal. Thanks to his tissue donor he is now fighting for a place in the England squad ahead of next year’s World Cup. l
New cord blood centre A
new centre for the collection of vital cord blood donations has been opened in London. Mums giving birth at St George’s Hospital in Tooting, one of the largest teaching hospitals in the country, will be able to donate cord blood to the NHS Cord Blood Bank which supplies blood to patients suffering from leukaemia and other illnesses. Cord blood is blood that remains in the placenta and umbilical cord after a baby is born. It is rich in stem cells that are similar to those found in bone marrow, and is useful for both treatments and research. Donations to the NHS Cord Blood Bank are given on a voluntary basis and can potentially help any patient in need of a stem cell V personality Richard Blackwood transplant. and Choice FM breakfast show Offically opening the centre presenter Martin Jay were just two of last month, Public Health Minister, the 300 people who gave blood during a Gillian Merron MP, (above third week of special blood donation sessions from right) said, “Cord blood offers organised in memory of blood and bone enormous potential to treat and marrow campaigner, Daniel De-Gale cure. The NHS Cord Blood Bank (pictured right). offers cancer patients greater The week marked the first anniversary access to potential life-saving stem of Daniel’s death on 8th October 2008. cell matches.” Daniel had won his long battle against leukaemia, but died aged 21 Lynda Hamlyn, NHSBT chief from complications. He was diagnosed in 1993. executive, added, “The location of The week aimed to encourage black and mixed race communities St George’s allows collection from across England to remember the legacy of an inspirational young a large multi-ethnic community, man whose life gave hope to leukaemia sufferers. It was the shortage which is of great benefit as patients of donors from the black community that inspired Daniel’s mother have a much better chance of Beverley De-Gale and her partner Orin Lewis to launch the African finding a good match from donors Caribbean Leukaemia Trust (ACLT) in 1996. l of the same ethnic background.” l
Remembering Daniel
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DONOR ONLINE
Just a click away
A swine flu pandemic could create huge challenges for all types of services and businesses.We have made detailed plans to cope in the event of a major outbreak
Sit back and organise your next appointment through Blood Donor Online blood products we have made from your donation – red cells, platelets, and plasma – now you can find out. Just check for the product symbols next to the date and venue of your last few visits. The system can also tell you which award you are due next and how many donations it will take to reach it. Another useful feature is you can check donation guidelines
Stars of Blood Donor Online The media library will give you the chance to see and hear the many celebrities who have supported us over the years. You will probably remember our popular and successful TV ads which ran from 2001 – 2008 and featured people like Sir Richard Branson, Mo Mowlam, Gordon Ramsay, Carol Smillie and many others. They’ve all either needed blood themselves or know someone close to them who has. Check the list below and see how many can you remember. Alesha Dixon backed our Circle of Life campaign to encourage more black and Asian donors. Rowan Atkinson featured in a surreal advert in the 90s, trying to get blood from a stone. Robert Powell provided the voiceover for ads in the late 80s. Ernie Wise successfully persuades a reluctant Glenda Jackson to give blood. l
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How we prepared for swine flu
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online, which means you know before booking an appointment whether any trips abroad, medical conditions, medications or your profession could affect your ability to donate. For those of you with an interest in the media history of blood donation, we also have plans to introduce a new media library to the site. Once complete, it will feature all our current and old TV and radio commercials, from the old gruesome ones showing a lady cutting her hand while cleaning windows and a dock worker in a car crash to the more light-hearted ads reminding donors to tell us about their change of details when they move house. A number of short films and documentaries about blood, blood donation and organ donation will also be put on the site. So, don’t miss out! Sign up to Blood Donor Online today at www. blood.co.uk l
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hen flu cuts a swathe through an office, paperwork and orders may back up but usually nothing more serious is at stake. But when any service connected with health is affected, much more is at risk. That is why, as soon as we became aware of the threat of a swine flu pandemic, our Emergency Planning team swung into action. Its role is to ensure that we can respond to any emergency situation. The team has detailed plans covering a number of potential scenarios, including a flu pandemic. Their priority is to ensure that the operational staff
BSIP, LAURENT / YAKOU / SCIENCE PHOTO LIBRARY
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ou may already shop and pay bills on-line. Well, now you can arrange your next donor session online – and a whole lot more. By registering on our website you will be able to book your appointment, change your details and check your recent donation history. To get started, use the links on www.blood.co.uk. You will need to be a registered blood donor and know your donor number. You can find this on letters we send you and also your blood donor card. The site has a step-by-step guide to take you through the registration process. We take security of your personal information very seriously and protect your data with a very secure system which is part of the Government Gateway. This uses several layers of security and encryption techniques. Once you have logged on at Blood Donor Online you will be able to see how many donations you have made and when you are next able to donate. You can then book or rearrange an appointment. If you have ever wondered what
SWINE FLU UPDATE
Follow the Department of Health’s advice: Catch It, Bin It, Kill It.
who manage our response to emergency situations are aware of the plans, are trained and ready to respond. That way we should be able to operate closely to normal
Flu response activities l Establishing relevant teams to co-ordinate activity across NHSBT. l Reviewing existing flu plans. l Re-auditing suppliers so that we have a reliable source of services, equipment, materials and consumables e.g. blood bags. l Rolling out hand gel to all key sites and promoting good hand hygiene to limit the spread of the virus. l Putting in place for staff a vaccination programme against seasonal flu and swine flu. l Building red cell stocks to 65,000 units by early September. This means communicating with donors to ensure this target is met. l
during and after any emergency.
The swine flu challenge Richard Rackham, who leads our Flu Resilience response, says, “When swine flu first appeared as a threat in April this year we put the organisation on ‘standby’, began the preparations outlined in our existing pandemic flu plans and initiated a proportional response.”
Building blood stocks “Work had already been done on the effect of flu on blood stock,” says Richard. “This showed that stock was vulnerable to pandemic flu. The best way to ensure sufficient WINTER 2009 THE DONOR
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stock was available was to have a good stock at the beginning of the pandemic wave.” He adds, “We knew the virus would come in waves so we expected to see an early peak in cases followed by a second wave later in the year. We knew if people
“building stock to 65,000 units was the best start in seeing us through a predicted second wave of the virus” were sick they couldn’t give blood and, based on previous experience, the demand for blood would drop slightly as hospitals may be forced to cancel operations if patients or staff were unwell or absent in large numbers. “With this in mind the executive team agreed that building stock to 65,000 units was the best start in seeing us through a predicted second wave of the virus.”
As predicted, the number of reported cases of swine flu dropped over the summer months. However, infection rates are climbing again, and, at the time of writing, stand at 53,000 new cases every week (Times 23 Oct 2009).). Richard says the target is to keep blood stocks at target levels. “We will keep our plans under review to make sure they are proportionate. We have already gathered up our flu teams to work through ‘real’ exercises to make sure our plans There is plenty of advice work in as realistic a situation as available to help reduce the risk of catching swine flu possible.”
Advice for donors Patients need blood for vital treatments every day, so it is really important for all donors who can to continue to give throughout the winter months. So if you feel well and meet our normal donor
Dodging flu Make it less likely you will catch flu by following the Department of Health’s advice: Catch It, Bin It, Kill It. Cover your nose and mouth with a tissue when you cough or sneeze, throw away the tissue, and wash your hands straight away. Regular hand washing may also reduce the chances of catching the virus. �
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THE DONOR WINTER 2009
selection rules (including the overseas travel rules) please continue to donate, keeping to your appointment in the normal way. However, if you are unwell with flu-like symptoms, you should not give blood. Please ring NHS Direct or your GP for further advice. Flu-like symptoms can also be compared on-line on the symptom checker at www.nhs.uk or you can call the NHS Swine Flu information line on 0800 1 513 513. As usual, if you become unwell in the two weeks after giving blood (except for a cold or a cold sore), or you believe there is a reason that your blood should not be transfused to a patient, please ring our donor helpline as soon as possible on 0300 123 23 23. �
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Blood buddies
As a child, Julia Moloney-Smerdon (left), 27, went with her mother to blood donor sessions and knew she wanted to give blood too when she was older. But what decided it was when, two years ago, her best friend Hannah was diagnosed with osteosarcoma, a type of bone cancer. Hannah endured months of chemotherapy and operations on her knee – all the while receiving transfusions.
“Until then I naively thought blood was only given to car crash victims and emergencies,” Julia says. “It never even crossed my mind that patients suffering from cancer would need blood to help them.” Hannah is now doing well and enjoying life to the full. Julia has gone on to encourage family and friends to give blood, because as she says, “You never know when, where or why we may need blood one day.” l
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PATIENT STORY
Little Jack’s miracle J
ack Cooper was a healthy baby until he was six months old. Then he developed a persistent cold and cough that wouldn’t get better. Understandably worried, parents Steve and Ruth took Jack to hospital. Ruth says, “We were worried because Jack couldn’t stop coughing and had difficultly breathing properly. Chest x-rays showed shadows on his lung. He was put on oxygen and doctors told us that he had pneumonia.” But this was only the start of baby Jack’s problems. Blood tests showed he was suffering from Severe Combined Immunodeficiency (SCID). SCID is a rare, inherited disorder causing a severe abnormality of the immune system, making it difficult for the body to fight infections. If left untreated, it is fatal. After the diagnosis, Jack was transferred immediately to the intensive care unit at Great Ormond Street Hospital in London. The most effective treatment for
Rich in stem cells, cord blood can help to cure many life-threatening diseases. For the Cooper family, it was their best hope for helping baby Jack
Jack with his parents Ruth and Steve (left) and sister Lauren (above) blood and platelets almost daily. He had his cord blood transplant in November 2003 and has gone on to make a full recovery. Says Ruth, “Looking at Jack now, you’d never know he’d once been so ill. He’s now a normal little boy. The cord blood donor not only saved his life but gave us the
SCID is a stem cell transplant and there was no time to lose. A search began for a suitable match. Stem cells have the potential to
develop into many different types of cells in the body. To treat Jack, the plan was to introduce the stem cells into his body in the hope that
Severe Combined Immunodeficiency Children with Severe Combined Immunodeficiency (SCID) have poorly-working immune systems. Their white blood cells, responsible for fighting infection, are missing or not working properly. Sufferers are vulnerable to infections which can easily lead to serious complications.
So coughs and colds are more severe and last longer,
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they would rebuild his immune system. Stem cells are found in the bone marrow and in cord blood – the blood that remains in the placenta and umbilical cord after a baby is born. “It was a deep shock finding out that our son had something so serious, but in some ways a relief,”
THE DONOR WINTER 2009
whilst common childhood illnesses like chicken pox or measles can become life-threatening. Problems generally occur within the first three to six months of a baby’s life and the diagnosis is confirmed by a blood test. Great Ormond Street Hospital and Newcastle General Hospital are the two specialist centres that treat children with SCID. l
says Ruth. “The medical staff were very reassuring and knowing what was wrong with Jack felt like a step closer to making him better.” The cord blood match for Jack had to be exact. Ruth remembers the stress of waiting. “It was tough not being able to do anything, but we stayed positive. We were told that Jack was a priority so we were hopeful that we wouldn’t have to wait long. We were really lucky that it was found within five weeks of his diagnosis.” During the wait, Jack received
chance to be a family and we will be forever grateful. Although I’d heard about cord blood before, it wasn’t something I’d ever really thought about. If you’re asked about donating cord blood it really is something you should consider. The way it is collected is painless and it really can be life-saving.” To find out more about cord blood donation visit cord.blood. co.uk l
NHS Cord Blood Bank The NHS Cord Blood Bank was set up in 1996 to collect, process, store and supply cord blood. It is a public cord blood bank and part of the NHS, which means, unlike private cord blood banks, a donation could potentially be used to help someone else as well as your child.
The NHS Cord Blood Bank is the fourth largest single blood bank in the world, with donations taken from the following hospitals – Barnet General, Northwick Park, Watford, Luton and Dunstable and St George’s Hospital in Tooting. These were chosen because of the wide ethnic mix of mothers who provide the cord blood. In order to match donations with patients, ethnicity is an important factor and it is likely that the donor and recipient will be from the same ethnic group. A wider mix of donors increases the chances of finding a suitable tissue type match. l WINTER 2009 THE DONOR
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BLOOD DONATION
BLOOD FACTS
Making donating easier
Living with thalassaemia
Donors in Poole can now pop into their local Boots store to give blood. It’s all part of our drive to make donation easier
In the UK, hundreds of people live with the inherited blood condition, thalassaemia. Thanks to better treatments, sufferers can enjoy a full and active life
met with the local management team from Boots who were keen to help us develop a similar facility. When we looked into it further it was clear Poole had real potential for platelet donors. “The central position of the shopping centre offered easy e know that finding access for donors. The area team the time to donate is were keen to get on board. Putting a challenge for many all these factors together gave us of you. Giving you the choice of making a donation through an appointment or walk-in is one way we have tried to make life easier, but we’d like to do more. So we’re exploring new ways of bringing donation services closer to you, starting with a new blood donor suite we launched last year at Boots UK The official opening of the in the Dolphin Shopping Centre, donor suite in Boots, Poole Poole, Dorset. We were keen to see how people responded to the confidence that the Boots Poole donor sessions being offered in a donor centre would be a winner.” totally new venue, rather than the Popular service traditional village hall or school. “Blood donation is such a vital Opportunity service that helps many people Deputy director of blood donation, across the UK every year,” says Tricia Paddy Nugent, says, “Poole offered Kennerley of Boots UK. “When a fantastic opportunity to NHSBT. Boots was approached to open a Our research told us that Boots was blood donation facility within our a trusted brand. That was important store in Poole, we were extremely to us as our relationship with donors pleased to be associated with this important initiative and to become is based on trust. “A brand new NHS health centre involved with the development of had just opened in the Boots Poole such a great scheme. Since opening store and was very successful. We in November 2008, the service has
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proved very popular and we are really proud to be working with and supporting the NHS in providing the local population of Poole with this blood donation service.” At the Boots suite, donors can give either whole blood or platelets. We are working towards providing 80 per cent of all platelets through component donation, so the new suite will make reaching this target easier. Offering platelet donation at Poole gives donors an alternative to the Southampton blood centre 30 miles away, whilst new and existing whole blood donors also have more choice. Kevin Hall, a platelet donor, appreciates the flexibility of the new suite. “The convenience is great because I used to live out in the sticks. At the Poole clinic they work around us and fit in with when we work. The facilities and the staff are both excellent.” The suite’s opening hours have been extended to offer evening and weekend sessions, and the suite now opens Wednesday to Sunday. We are hitting our targets in terms of donor numbers, and platelet donors are making regular repeat visits so the suite is clearly popular with all kinds of donors. With the success of the Boots venture under our belts, we are looking at adding other new donor suites in totally new venues. l
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halassaemia is a blood disorder that affects the haemoglobin in the red cells, the chemical that carries oxygen around the body. It is most common in people who originate from Mediterranean countries, the Middle East, Africa and Asia. As the distribution of thalas saemia coincides with that of malaria, it’s thought that carriers of the thalassaemia gene have some protection from malaria. Haemoglobin is made up of
chains of proteins and to work properly, adult haemoglobin needs both alpha and beta chains (there are two of each). A mutation that affects the alpha chain causes alpha thalassaemia, and a mutation of the beta chain causes beta thalassaemia. Thalassaemia is not something you catch or develop. It’s an inherited disorder. In order to have the condition, a child needs to have inherited an affected gene from both parents. If they inherit only one gene then they will simply be a
How the trait is passed on
When one parent has one affected gene, s/he has the thalassaemia trait, and is called a carrier. If the other parent has no affected genes, then, on average half of their children would have normal haemoglobin and half would be carriers for the thalassaemia trait.
carrier of thalassaemia (sometimes called thalassaemia trait), and will usually suffer no ill health and need no treatment.
If both parents have thalassaemia trait i.e. each has one affected gene, then, on average, one in four of their children would suffer from beta thalassaemia major, two in four would be carriers, and a one in four would have normal haemoglobin.
Alpha thalassaemia There are two genetic types of alpha thalassaemia, alpha plus and alpha zero. Alpha plus is the mildest form and does not affect the individual’s health. About one in three people originating from Africa or the Indian subcontinent are carriers. Alpha zero is uncommon and carriers of the gene are not affected. If both parents are carriers some of their babies could inherit two copies of the affected gene and develop severe anaemia.
Beta thalassaemia This takes three forms. Beta thalassaemia carrier or trait is the mildest , and arises in someone who has inherited only one affected gene. The affected person is usually healthy and without symptoms. However their red cells may be slightly smaller and paler than those of people without the trait. People with beta thalassaemia intermedia inherit a thalassaemic (or poorly functioning) beta gene from both parents, but are only mild affected and often keep well without extensive medical intervention. People with this form can suffer from a mild form of anaemia and it can affect a child’s physical development. WINTER 2009 THE DONOR
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COVER STORY Beta thalassaemia major is the most clinically severe type and sufferers will need life- long treatment to survive. The condition can lead to severe anaemia if untreated. With treatment, children can survive to adulthood but face health complications.
Treatment At the moment there is no safe and effective cure for thalassaemia and for those with beta thalassaemia major, blood transfusion is the first line of regular treatment. This is life-long and patients need to attend hospital every four to six
weeks. The transfusions can help by ‘topping up’ the haemoglobin in the blood and therefore reducing the anaemia. Unfortunately there are side effects associated with these repeated transfusions. Patients absorb iron naturally from the food they eat and this combines with the iron from the blood transfusions and builds up, causing an ‘iron overload’ (called secondary haemochromatosis). If not treated, it can cause harm to vital organs such as the liver and heart. Iron overload can be controlled by a treatment called chelation
therapy. A special drug is injected into the patient over several hours, often while they sleep at night. The drug binds with the iron which is then removed from the body by the kidneys. Before this treatment was available, most thalassaemia patients died when they reached about 20, usually due to heart problems. Medical advances, such as chelation therapy drugs in tablet form, will make life much easier for sufferers, and some patients are already being treated this way. Other drug treatments are also being tested in clinical trials. l
“I want to do what everyone else does” Rajpal was 18 months old when he was diagnosed with beta thalassaemia major. Both parents have the thalassaemia trait and two of his brothers, but none of his sisters.
Now aged 28, Rajpal is affected in different ways by his illness. His anaemia makes him feel tired and weak, he can never forget his vital hospital appointments where he receives his transfusions. As a teenager, Rajpal found it hard to go out because of his strict daily regime of pump-driven injections which could last around nine hours to remove the excess iron from his blood. Today he takes treatment in tablet form and this has given him more freedom. But he still needs a blood transfusion every three weeks. Having thalassaemia hasn’t stopped Rajpal living a full life. He works as housing officer, loves to play snooker and is an avid football follower. “There is no point in feeling sorry for myself and I don’t want anyone to feel sorry for me,” he says. “I still want to do what everyone else does, go clubbing, whatever. Having seen first-hand the benefits of blood donation, I would encourage family and friends to give blood, especially those from the black and minority ethnic communities, as there are not enough donors. “ l
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teful for an “I’d be very graneeded one.” organ if I
Two advertisements from the organ donation campaign
register “I’m too old to n’t I?” as a donor are
“If I ever needed an orga n, I’d obviously take one. ”
the us have joined only 27% of lives. one would. But help to save Nearly every of all ages can needed one? are – people an organ if you er how old you it. Would you take doesn’t matt ation, prove r Register. It don an 23 Organ Dono org 23 123 eve in .nhs.uk 0300 If you beliat organdonation Register now
“I might register as a donor, but not right now.”
Would you take an organ if you needed one? Nearly Organ Donor Register. everyone would. But Three people who need only 27% of us have joined the a transplant die every day due to the shortage If you believe in organ of organs. donation, prove it. Register now at orgando nation.nhs.uk Text JOIN to 84880
Prove it!
NHS Blood and Transplant (NHSBT) is the organ donation organisation for the UK, responsible for matching and allocating donated organs. This important Our campaign to sign up more organ donors started part of our work means that every in November. Nearly everyone (96 per cent) in the year, thousands of people receive life-saving transplants. UK would take an organ if they needed one, but only Last year there were over 3,500 27 per cent are signed up to the NHS Organ Donor transplants, ranging from heart and kidney to tissues such as bone and Register. Our new message says: if you believe in tendon. This is the highest number organ donation, prove it on record, yet more than 1,000 people are dying every year (that’s three a day on average) before an the ODR (27 per cent). The UK has prove it by registering on the ODR. organ becomes available. one of the lowest rates of organ You will be pledging to helping donation in Western Europe at 13 someone live after your death. In Low rate donors per million of population fact, a single donor can transform Over 16.5 million people have now whilst Spain has the highest rate at up to nine lives. The NHS Organ Donor Register registered on the NHS Organ Donor 35 donors per million. That’s the background to our records the details of people who Register (ODR), but many more are needed. There’s a huge gap new campaign, launched on 2nd have registered their wishes to between those who would accept November across TV, radio, digital donate organs and/or tissue after an organ if they needed it (96 per and press. The campaign’s message their death for transplantation. This cent) and those who have joined is: if you believe in organ donation, information is used by authorised Page:1
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Right: Support for organ donation is high (96 per cent), but only 27 per cent of people have signed up to the Organ Donor Register. At our campaign launch, 27 people hold up a photograph of 96 individuals to illustrate the gap. Below: Have a heart! At the Wizard of Oz-themed London photocall, heart transplant patient Louisa McGregor-Smith, dressed as Dorothy, hands a huge soft toy heart to a Tin Man Ready to act Nearly half the people in the UK (who famously had no heart) say they want to sign up to the ODR and commit to donating their organs for transplantation after death, but just haven’t got round to it. Lynda Hamlyn, chief executive of NHSBT, explains the campaign’s approach. “Many people have told us that they between the number of us who just need a nudge to motivate them say we would accept an organ if we to join the Organ Donor Register needed one and the number who and commit to helping someone have actually joined the Register, live after their death. our campaign highlights the urgent “By focusing on the gap need for those who believe in organ medical staff to establish whether a person wanted to donate. Kieran Sandwell waited over a year before a heart was found for him. He says, “Receiving a heart made the difference between life and death for me. I believe that if you would be willing to take an organ, you should join the Organ Donor Register. Please – do it today.”
Building support Over 3,000 people have joined our Wall of Life as word spreads through social networking sites. Launched
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THE DONOR WINTER 2009
their wishes with their families.”
Campaign launch
donation to act now. More transplants were carried out last year than ever before, but the need for organs never stops. If you believe in organ donation, please register today and let those closest to you know that you have done so.” Health Secretary Andy Burnham says, “Each year, organ donors transform the lives of thousands of people. Most of us support organ donation and the overwhelming majority would take an organ if we needed it. I would urge everybody who supports organ donation to show it by signing up to the Organ Donor Register and discussing
earlier this year, it’s part of a nationwide campaign to promote organ donation. The Wall of Life is an online mosaic created from people’s photographs. The photos eventually come together to make up the image of two-year-old Louisa McGregor-Smith whose life was saved by a heart transplant when she was just five months old. But at least 60,000 people need to upload their photos to complete Louisa’s image, so there’s still some way to go. The official Twitter feed to the Wall of Life has already attracted over 325 followers while our Facebook group now has 498 members. You can encourage friends and family to show their support for organ donation and sign up to the NHS Organ Donor Register. l
On the day of the launch, there was a colourful photo call at St Thomas’ Hospital in London (pictured left). An arresting image was 27 people holding up a giant heart-shaped photograph of 96 individuals – demonstrating the gap between the 27 per cent of people signed up to the ODR and the 96 per cent who support organ donation.
Everyone can register Organ transplantation has attracted its fair share of myths. Two of the most common are that people can be too old to donate, or be unable to donate because of a medical condition. In fact, anyone can sign
“It’s what she would have wanted” When Eileen and Stan Stephenson faced the heartbreak of losing their youngest daughter, Katie, they took comfort in knowing her organs would go to help others. Katie, a nursery nurse from Hull, went to hospital in February 2006 feeling unwell. She was diagnosed with pneumonia but deteriorated quickly and within 24 hours was on life support then died shortly after from a stroke. Years earlier, when Katie was 12, she had come home from the local shops with a donor card and asked her parents if she could carry it because she wanted to be a donor after her death. Eileen says, “When we were approached about donating Katie’s organs I said yes straight away because I knew it was what she would have wanted.”l
recorded cornea donor was 104. Some people also think that being an organ donor would conflict with their religion. But, in fact, the leaders of all the major faiths in this country have given their support for organ donation. Transplants save lives. So, please Left: Pictures from the join the NHS Organ Donor Register new TV campaign today and let those closest to you know so that they can respect your wishes about organ donation. l
up as an organ donor and there are very few illnesses that prevent someone from donating their organs after death. Organs are successfully transplanted from people in their 70s and 80s and the oldest
Sign up now You can join the ODR by: l Filling in a form at www.organdonation.nhs.uk l Calling the NHS Donor Line on 0300 123 23 23 l Texting SAVE to 84118 You can also join when you are: l Registering for a driving licence l Applying for a Boots Advantage card l Registering at a GP surgery l Registering for a European Health Insurance Card (EHIC) WINTER 2009 THE DONOR
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OVER TO YOU ������������� STAR LETTER �������������
Water fixes fainting problem
A Star Letter is chosen for every issue. The winner will be A few sessions ago, I got off the bed too quickly and felt faint. After that, I always invited to a behind-the made sure I took a bottle of water with me to drink whilst donating, and remained tour of a Blood on the bed for a further 10-15 minutes. I also drank several cups of water at the donor -scenes Centre. He or she will table afterwards. don a white coat and There was a new procedure when I donated this week. see what happens to a donation of blood. (You Donors were asked to drink a glass of water just before must be 16 or over.) donating, which I did. I then drank my bottle of water whilst
donating. But this time I felt 100 per cent better. I didn’t stay on the bed and had one glass of water at the donor table. Once at home I carried on as normal and couldn’t stop saying how much better this new procedure is. GAIL LEMARE , BY EMAIL
EDITOR’S RESPONSE: We are very pleased the new procedure seems to be
working well. We explained the reasons behind the change in the last issue of The Donor.
���������������������������������� This is your chance to tell us your news, views and interesting or unusual donor stories. Write to The Editor, The Donor, NBS Colindale Avenue, London NW9 5BG or email thedonor@nhsbt.nhs.uk
My online donating story I have always wanted to donate blood and last week I decided that, now I am 17, it was the time to do it. I was surprised at how simple and painless it was. But I was shocked by the reactions of others around my age who thought it was ‘weird’, ‘odd’ and ‘unnatural’. From this, I had the inspiration to talk to others from my age group in a way we all understand. Youtube! http:// www.youtube.com/watch?v= e0LXjwx70iQ This video is my way
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of showing the world how easy donors from the Barrow area will blood donation is. I hope it attracts a be in touch soon. load of young adults to donate! LEE RAE BY EMAIL
EDITOR’S RESPONSE: It’s good to hear
how well your first donation went and that you’ve been encouraging others to follow your example. We hope to see you again soon!
Sharing the cost I was wondering if you could help with a request to find any regular platelet donors from the Barrow- inFurness area who, like myself, have to travel to Lancaster to donate, and so would consider sharing the cost and the driving on a regular basis. If anybody is interested they can email me through thedonor@ nhsbt.nhs.uk KEVIN SMITH BY EMAIL
Oops!
I have booked next week off work and thought what better way to relax than to catch up on some new books I had been given. However you have now spoiled the ending of one of the books I was about to read! The Cecilia Ahern book you featured in the last Donor magazine does not tell you on the blurb of the book that the reason for her experiencing her feelings of déjà vu are due to her having had a blood transfusion; but as you let that slip you have now ruined the ending for me and perhaps many others! Looks like I will have to spend my time clearing out the cupboards instead!
EDITOR’S RESPONSE: This is a great LOUISE HURLEY BY EMAIL idea and I am sure that other EDITOR’S RESPONSE: Apologies for
THE DONOR WINTER 2009
FFFFFFFFFFFFFFFFFF Margaret keeps on giving Margaret Gunning is certainly one of our most loyal blood donors, with over 50 years of donating under her belt. She gave her first pint back in 1956 whilst working as an apprentice at a clothing firm in West London. Says Margaret, “We were allowed a one hour paid lunch break to donate blood and this encouraged me to go.” When she moved to work at a soft furnishings shop in Radlett, Hertfordshire, Margaret began donating platelets at the Edgware donor centre. “This was the nearest venue and I attended sessions there every fortnight,” she told us. Margaret has made over 700 donations of blood and platelets. “I retired from my job at 70 and still donate blood as frequently as possible. It’s my way of giving something back to the community and I am pleased to be able to help.” l
FFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF WINTER 2009 THE DONOR
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OVER TO YOU inadvertently ruining the plot for you. We hope you had a good holiday nonetheless. You’ll be pleased to hear that we haven’t featured any book reviews in this edition of The Donor!
A different donation Many women who give blood will have to take a break from donating when they have a baby, until nine months after the birth. I just wanted to let women know that they can continue to save lives during those months by donating breast milk for babies. They can find information at www.ukamb.org. I have donated blood and breast milk and am happy in the knowledge that I have
My Life
really made a difference to others in and more overseas postings it my own little way. wasn’t until 20 years later, 1978, whilst living in Bedford that I Fiona Cullen by email EDITOR’S RESPONSE: Thank you for started donating again. In 1981 this information. I am sure lots of my husband needed many blood new mums who currently can’t transfusions. I was determined to give blood will be interested to pay it all back. Now that we can donate after the age of 70 I’m up know of this scheme. to 67 donations and am so pleased Keeping on giving I’ve repaid it all with interest. I gave my first donation at HMS Pamela miley, SomerSet Nuthatch in Anthorn, Cumbria in EDITOR’S RESPONSE: Lots of donors 1957 whilst serving in the Wrens. have written to say how delighted There were many Wren volunteers they are by the removal of the but only a few sailors and one or upper age limit for regular blood two of those fainted. Then, the donors. We are encouraging only criterion for donating was that those donors to write in and you’d never had jaundice - how tell their stories as we’d like to times have changed! But with an feature them in future editions of overseas posting, marriage, children the magazine.l
IS IT TRUE THAT… We reply to some of your questions about donating
Q
I am partially sighted and always have extreme difficulty filling in my medical information form when I give blood.I am surprised that now that we have the Disability Discrimination Act,I still cannot get a large print medical questionnaire,which would enable me to fill the form in easily.I have given nearly 80 donations and in all that time I have been unable to obtain a large print form. We are currently reviewing the Donor Health Check questionnaire and can tell you that once the latest version is ready, we will be looking to have large-print versions available. A few years ago I took part in an NBS pilot scheme.It allowed you to book and track your blood donations online.I never heard any more and wondered if this was officially live? How do I get enrolled for Blood Donor Online
A
Q
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so I can plan my next donations and see what’s happened to the blood I’ve already give? Blood Donor Online is live at the following web address - https:// donor.blood.co.uk/Microsite/.You can register there and track your donations as well as booking appointments and changing any personal details. See p8 of this issue for more information. Where can I find out more information about being a blood donor and the impact of swine flu? Please call the Donor Helpline for information about swine flu and whether you can donate.Alternatively there is information on our website.Also, see our feature on pages 9 and 10. Recently I have been receiving some physiotherapy for a back complaint. Part of the physiotherapy included a couple of sessions of
A
Q A Q
THE DONOR WINTER 2009
acupuncture. I thought no more about this until I went along for my regular blood donor session a week or so later. During the registration process I explained the reason for the acupuncture.What I hadn’t realised was that I needed a certificate to prove that the establishment where I had received the acupuncture was on the accredited list. Unfortunately without the certificate I wasn’t able to donate blood. This is the case and donors are reminded to obtain a certificate to ensure that they can continue donating as usual.We are currently reviewing the rules on acupuncture. If it is done through the NHS there is no waiting time. If not, you need a certificate to show the acupuncturist is qualified, otherwise you have to wait four months between treatment and donating. l
A
When a blood transfusion can be a death sentence
I
t’s easy to take our blood services and NHS care system for granted. But in many parts of the world, a safe reliable supply of blood is simply not available. Lack of money, equipment, technology, and trained staff together with a shortage of donors mean that millions of people all over world do not have access to a safe blood donation service. Dr Margarita Sarishvili, who was born and raised in Georgia when it was still part of the Soviet Union, is well aware of this gap. After completing her medical studies in Tbilisi, Georgia she became a specialist and worked part-time as an emergency doctor. She saw first-hand the challenges the local blood service faced, with its reliance on paid donors and unsafe processing methods. Five years ago, Margarita came to the UK as a visiting fellow at the University of Bristol, and proceeded to complete an MSc in public health at the University of the West of England, with a focus on the national blood supply and its impact on public health. She began working in the blood processing unit at our Filton blood centre, and is currently working
Dr Margarita Sarishvili recently took time out from working at our blood centre in Filton to travel to Afghanistan. She explains the difficulties Afghans face in accessing a reliable and safe supply of blood
Above and left: Dr Sarishvili (in black), with fellow professionals in Afghanistan voluntary blood donation programme in Georgia.
Going to Afghanistan
towards a PhD at the University of Sheffield. She wants to help improve her country’s blood service and is looking at social marketing and health policies for a proposed
Margarita was approached to work in Afghanistan in 2008 because of her background in transfusion medicine in Georgia. Margarita explains how the blood services of both countries continue to experience many challenges. “My objective was to investigate how technology and standards of practice in the blood transfusion
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SESSION UPDATE service in Europe and the UK could be transferred to Afghanistan. Georgia and Afghanistan face many problems with their transfusion services particularly in terms of difficulties in accessing a reliable and safe supply of blood and blood components. A transfusion of blood can save lives but it can be a death sentence. “ She spent a gruelling month out in the country, where a typical day began at 9:00 am and finished at 8:00 pm. She visited hospital blood departments in the capital, Kabul, talking to staff and donors to get an idea of how they worked and to gain a better understanding of their needs. She also ran a number of workshops for staff on blood banking safety. Her working conditions were vastly different to the UK. Safety standards were low, and staff often lacked training and expertise. Another major challenge she saw for the country’s blood service was the lack of voluntary donors. “This is due to culture and tradition,” says Margarita. “Only extended family members and close relatives are willing to give blood. However, in some instances replacement donors can be found who will donate for money.”
Changes for the better
W
The good news is that Afghanistan officials and doctors have shown a strong desire for the improvement of the system and funding is being provided by international agencies to change and modernise the service. Margarita adds,“My visit to
“Only extended family members and close relatives are willing to give blood. However, in some instances replacement donors will donate for money”
Donation risks The dangers of this are obvious. Family members may hide risky behaviours which have exposed them to blood-borne diseases which they could then pass on through transfusion. In Europe and the UK only voluntary blood donors are used and blood is much safer as a result.
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Afghanistan was excellent. I was able to involve those most eager to learn safe practices; these medical professionals were then able to go
THE DONOR WINTER 2009
A family coming to collect blood for a relative. The lack of cold-chain storage and transport poses problems for blood safety in Afghanistan back to their communities and apply and share their new knowledge.”
Life at Filton At our state-of-the-art blood centre in Filton, Margarita works in the blood laboratories from 3:00 pm 11:30 pm, Fridays and Saturdays. Her work is very hands-on, dealing with blood components and the processing, monitoring and quality control of blood collection and platelets. She says, “I am fortunate to have had the opportunity of training in the UK and to develop ways to improve the safety of blood donation in my native country. I know that in the UK, should I ever come to need blood, it will be safe and that it was donated by someone who only wanted to give the gift of life.” l
henever we asked you Our new programme for improving donor what improvements sessions has reduced waiting times for donors you wanted, you told us that reducing the time taken to and boosted our productivity donate was what you would most like to see. We clearly needed to make our donation sessions more efficient so that you had the best possible experience. With that in mind, we implemented an operational transformation programme, which introduced improvements to how donation sessions are run. We tested the changes first in pilot areas, and found them so successful improvements to the appointment to keep improving the service. We that now every blood team has system. The teams that plan blood recognise that sometimes, on the adopted the new way of working. donor sessions can now fine-tune day, your experience can fall short every session at a local level. of your and our expectations. Our Improving efficiency They now adjust the number front line staff provide us with One change you may have noticed is of appointment slots available detailed information to ensure we that the session is laid out differently. taking into account factors such know just how your visit went. This Wherever possible everything is now as the busiest times at the previous helps us to understand where we session. With this information they went wrong and what we need to in one room. We found in our pilot studies that are better able to accommodate improve for you. There are sometimes occasions we could arrange the session in a those donors who like to book an much more logical way to improve appointment and those who prefer where the session is affected efficiency and to allow all the staff to simply turn up. This too has by a huge response to our calls for support from you. Sickness to readily spot and respond to any reduced waiting times . amongst donors and staff can also holdups. Simply being able to see all affect our best laid plans on the areas and all donors before, during Reduced waiting times and after their donation improves We constantly measure the day. In these situations, our staff both safety and the overall flow of benefits of the changes our staff work tirelessly to maintain the best the session. have worked so hard to implement possible service to you. During the period of changes Another change is the way the and we have seen a reduction in beds are arranged. In most venues waiting times in the majority of to our sessions, we really do appreciate your patience, loyalty now, the beds are laid out in a areas throughout the country pod arrangement which allows a Although we have made good and commitment to saving lives. We will continue our efforts to highly flexible team of staff to care progress with the operational for you during your donation. We transformation programme, this make the time you spend with us have also worked hard to make isn’t the end of our commitment even better. l WINTER 2009 THE DONOR
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PATIENT STORY
“After eight days, I finally woke up”
raised £500 of sponsorship for debt to blood donors. “In 2006, I his tandem sky dive in aid of the spoke at a blood donor ceremony Meningitis Trust. Last year, Oliver for people who had given 75 and ran the 10-mile Great South Run 100 pints of blood. I really enjoyed and is now completely recovered. it and have encouraged all friends Life may be back to normal for and family to donate where was so grateful to the district nurses – they visited every three days for Oliver, but he has not forgotten his possible.” l two weeks to change the dressings on my legs, arms and back.” For the next 18 months, Oliver visited the paediatric unit in l Meningitis means swelling of the lining around the brain and spinal Salisbury Hospital to receive steroid cord, typically caused by bacterial or viral infection. Meningococcal injections on his upper back and and pneumococcal bacteria account for most cases of the illness, shoulders to reduce the size of the and can also give rise to septicaemia. Viruses, such as herpes keloid scars (raised scars) left by the simplex, cause viral meningitis. illness. “I needed 40 injections in l The bugs that cause meningitis can also get into the blood one sitting, and slowly but surely, stream and cause septicaemia or blood poisoning. Meningitis and I began to feel better. I had been septicaemia can occur together or separately. given only a 20 per cent chance of l Symptoms can appear in any order, but the first symptoms are survival, but thankfully, I have been usually fever, vomiting, headache and feeling unwell. able to re-build my life again with l There are approximately 2,000 cases of bacterial meningitis in England personal determination and expert and Wales every year. The number of cases has dropped sharply in medical assistance.” recent years due to a successful vaccination programme that protects Life is back to normal both on and off the court for Oliver
Meningitis is a killer and teenagers are especially vulnerable to the disease. Oliver Janes was lucky that doctors could save him
O
liver Janes, 22, is like any sports-mad young man. He’s got several sporting challenges under his belt including the Great South Run and a tandem sky dive. He’s also studying for a degree in Sports Science at Loughborough University and coaches tennis part-time. But his life could have turned out very differently. In October 2004, aged 17, he contracted the most acute form of meningitis, meningococcal septicaemia, which causes blood poisoning and inflammation of the brain (see box). At hospital in Southampton,
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doctors found that his platelet count had fallen from a healthy 300 to less than 20. His left arm and leg were so swollen by septicaemia that doctors though they would have to amputate them. But thanks to their skill, and 27 blood transfusions, Oliver kept all his limbs and lost just a fingertip. As the whole drama unfolded, Oliver was unconscious. “Eight days after being admitted to hospital, I finally woke up,” says Oliver. “I had been in an induced coma and overcome the worst of the meningitis. Doctors couldn’t confirm how it was contracted but
THE DONOR WINTER 2009
said that it was both easy and rare to catch.”
Life after illness Adapting to life after this illness was hard. “At first, I was in such an awful state of pain. For the first two to three weeks in hospital I was in a wheelchair and had to learn to walk again. This was because of extreme muscle wastage due to weight loss. All the doctors and nurses were so helpful, caring and supportive and my family visited regularly too. “Without blood donors and the medical teams I would not have survived. Mum didn’t leave the bedside for six weeks; she stayed with friends in Salisbury so she could be there for me. “Eventually, at the end of November, I was able to go home. I
What is meningitis?
Sky dive Six months after his illness, Oliver was back playing tennis and later
against some of the bacteria that can cause the disease. l Bacterial meningitis is most common in children and babies under the age of three, and in teenagers and young people aged 15-24. WINTER 2009 THE DONOR
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MEET THE EXPERT
Good operating standards Q A
What does your day to day work entail? I look after elective orthopaedic surgery at St Helens, so I treat anyone booked in for non-emergency operations on lower limbs. I also do a lot of work at Whiston Hospital working on trauma surgery, those who have broken their legs or pelvis in a road traffic accident. I also do weekly clinics with patients before and after surgery. The days can be very busy and long hours, but I have a great support team who work with me.
Q A
How often is blood used in general orthopaedic surgery? We try to avoid using blood if we can in orthopaedic operations unless it’s
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Jordi Sanchez-Ballester is a consultant orthopaedic surgeon at St Helens Hospital, Merseyside. He talks about the importance of blood transfusions during operations and how keyhole surgery is helping reduce demand for blood products absolutely necessary. We operate carefully so that there is as little blood loss as possible. We generally only transfuse if a patient has a haemoglobin (Hb) reading of between seven or eight and if they are symptomatic. Generally, below
THE DONOR WINTER 2009
seven means transfusion is recommended unless there is a history of chronic anaemia. Anything above eight we don’t transfuse normally, because in most cases the patient is well enough for their body to reproduce blood cells at a normal rate. In trauma surgery, like a pelvic fracture, blood is transfused regularly if there is a great deal of bleeding associated with the injury. Is there more emphasis now on using blood only when absolutely necessary? Yes, most definitely. Things have changed over the years in the way we work in the operating theatre. A lot of keyhole surgery is done nowadays in orthopaedic surgery, which means we have very little blood loss during the operations and fewer scars on the patient afterwards. If I’m doing any major surgery below the knee I’ll use a tourniquet to avoid a lot of blood loss. There are times when blood transfusions are vital in
Q A
operations such as knee or hip replacements when there can be a higher than average blood loss. Probably fewer than 30 per cent of operations of this kind would require transfusion of donor blood, if previously cross-matched. How has the use of blood products changed during your career? The use of autologous blood transfusion is becoming more and more popular in modern surgery. It’s a way of collecting whole blood that is routinely lost from a patient during operations
Q A
“There are times when blood transfusions are vital in operations such as knee or hip replacements” and transfusing it back into them using a special machine. It is used more often during surgery for knee replacements or hip reconstruction – the operations where blood loss is more prevalent. It’s a preferred option to donated blood and reduces the risk of cross infection. Who makes the decisions to transfuse blood if it is needed during surgery and how would it be decided? I would consult with the anaesthetist about whether or not a patient needs a blood transfusion during their operation. It all depends on how much
Q
A
Jordi Sanchez-Ballester says keyhole surgery has meant fewer transfusions for patients blood is lost through surgery. The anaesthetist will check the amount of fluid collected, along with the number of swabs used during the operation and we would then decide between us whether or not a transfusion is needed. We do a cross matching of blood before surgery on patients we feel may need a transfusion because of the potential for major blood loss. We would then have donated blood of the matching blood group on standby in case it is needed, but that is not routinely done for each operation. Have you ever had any cases where someone’s life has been saved by blood during surgery? I have done my fair share of trauma surgery where someone has lost a lot of blood in say a road accident and has come to casualty with things like broken legs or a broken pelvis. This can be a prime example of someone needing blood to keep them alive because they have lost so
Q A
much during their ordeal. Do you follow up with patients after surgery? Yes. Always. When the patient has had their operation, they are taken onto a ward to recover. We then do blood tests 48 hours after surgery to get a haemoglobin reading and make sure their levels are ok. This will tell us if they need to receive a transfusion. If they do we would normally give them about two units to help build up their Hb levels again and get them on the road to recovery. Once they are discharged from hospital they will then come to see me for follow up as an outpatient in one of my weekly clinics. What do you do to relax after a busy day in theatre? I love sport and so do my three children. I play football with my teenage son regularly. I like to keep fit so try to go swimming and play tennis whenever I get the chance. I also like to entertain at the weekends or go out for a nice meal with my wife and family. I like my music too and there’s nothing like a good bit of Queen to unwind to after a busy day! l
Q A
Q A
WINTER 2009 THE DONOR
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ASK THE DOCTOR Our doctor, Sue Barnes, answers your questions on how frequently you can give blood
Q
Do I always have to wait 16 weeks before donating? Currently our donor selection guidelines do allow for more frequent donations, with a minimum interval of 12 weeks between donations, as long as the minimum haemoglobin levels are met. We test your haemoglobin levels each time you attend, so you will only donate if you meet the minimum level. Research shows that reducing the donation interval will not have any adverse effect on donors. This is obviously important as it means donors can give blood more frequently if donation rates fall, such as during a flu epidemic or the holiday season. However, we do not recommend that you donate every 12 weeks as a matter of course because in the long term it can lead to depleted iron stores and anaemia.
Giving regularly weeks but will need 12-16 weeks to replace the iron in those cells.
into red blood cells, rather than white cells or platelets.
Q
Q
What is happening during those 16 weeks? As you know, when you give whole blood you donate red cells. There’s an important link between your red cells and your health because it’s these cells, or rather the red coloured haemoglobin they contain, that take oxygen around your body. Haemoglobin contains iron and some is lost with each blood donation. To compensate, iron is mobilised from the body’s iron stores, and the body increases the amount of iron it absorbs from food and drink. After a donation, most people’s haemoglobin levels are back to normal after six to 12 weeks, and with a good diet your iron stores are back to normal after 16 weeks.
Q
How are red cells replaced? Special cells in the kidneys, called peritubular cells, sense that the level of oxygen in the blood has decreased (due to the loss of red cells) and start secreting a protein called erythropoietin. This passes Why do you usually ask through the bloodstream until it donors to wait 16 weeks reaches the bone marrow (the soft before making their next fatty tissue inside the bone cavities). donation? The bone marrow produces stem When you give whole blood we aim to take just under a pint (about cells, the building blocks that the 470ml) of blood, this usually works body uses to make the different blood cells – red cells, white cells out at about 13 per cent of your and platelets. The erythropoietin blood volume. Your body will sends a message to the stem cells, replace the fluid lost in a matter of hours, the blood cells in about eight telling more of them to develop
Q
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CROSSWORD
THE DONOR WINTER 2009
Is there a difference in the levels of haemoglobin found in men and women? Yes. Generally, men will have a higher haemoglobin level than women (150g/l in men and 135g/l in women). We test your haemoglobin levels every time you donate, to make sure they are above the safe level for blood donation. l
Boosting your iron
Iron is vital for making the haemoglobin in red cells. The body stores it in the form of two proteins – ferritin, which in men accounts for about 70 per cent of stored iron and in women 80 per cent, and haemosiderin. The proteins are found in the liver, bone marrow, spleen and muscles. You can support your iron stores by eating a variety of iron-rich foods. On average men need to replace about 1mg of iron per day, women 2mg. With a balanced diet, getting enough iron shouldn’t be a problem. Foods such as lean red meat, poultry, fish, leafy green vegetables, brown rice, lentils and beans can all boost your iron levels. Vitamin C helps iron absorption, so try a glass of vitamin C-rich fruit juice with your meal. l
Complete the crossword. The letters in the red shaded squares spell out a seasonal phrase. Send this phrase on a postcard or letter together with your name, address and daytime phone number to: Crossword Competition, The Donor, NBS, Colindale Avenue, London NW9 5BG. You could win an ‘Amazing’ NBS prize. Answers and the winner will be in the next issue. All entries must be received by 31st December 2009.
ACROSS
5 Angel (6) 7 Winner (6) 8 Wise men (4) 9 Christmas (8) 10 Songs for Christmas (6) 12 Purposeful trip (6) 14 Magnificent (6) 16 Bird sanctuary (6) 17 Set of beliefs (8) 19 Alternative to turkey? (4) 21 Certainly (6) 22 Meat pin (6)
DOWN
1 Dame ___ Lynn (4) 2 Male singer (8) 3 Resident of Edinburgh maybe ... (4) 4 ... and someone living in English equivalent ... (8) 6 ...perhaps here in Hillingdon (5) 7 Worth (5) 11 Present in great quantity (8) 13 Rudolph? (8)
15 You give it! (5) 16 Very deep pit (5) 18 Animals by the manger? (4) 20 Cook (4)
LAST ISSUE’S SOLUTION
WE HAVE A WINNER! Congratulations to Mrs C Pink, Bideford, Devon, who correctly answered last issue’s crossword. The correct answer was: BOOK AN APPOINTMENT NOW. WINTER 2009 THE DONOR
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Blood stocks run low at Christmas
Please give blood... . . .you could save someone’s life...today
INFORMATION Just call our 24 hour Donor Helpline and staff will answer your queries on all aspects of giving blood.
Remember, you can call the Helpline to tell us if you have moved house or changed employers! DON’T FORGET information is also available on our website.
0300 123 23 23 www.blood.co.uk We always need new donors. So please, if you are not a donor, fill out the coupon below, place it in an envelope and send it to National Blood Service, FREEPOST, 75 Cranmer Terrace, London SW17 7YB, or call 0300 123 23 23 now to enrol as a donor. Mr/Mrs/Ms/Miss
SURNAME
FIRST NAME
DATE OF BIRTH D D / M M / Y Y
ADDRESS
POSTCODE
DAYTIME PHONE No
To give blood you need to be in good health, aged 17 to 65 and weigh over 7st 12lbs/50kg. I would like to join the NHS Blood Donor Register as someone who may be contacted and would be prepared to donate blood. I understand that the National Blood Service (NBS) or its partners may phone, write or otherwise contact me with details of local donor sessions. I agree to the NBS holding my personal details on their donor database and processing this information as necessary for the proper administration of the NBS. MO6