The WHO want all blood donations to be voluntary and unpaid, but in many countries blood is given by family members or friends. Quite simply, the patient has to contact relatives and hope that they want to donate their blood. In this situation there is a considerable danger of being subjected to social pressure and giving blood even though they have perhaps recently had a blood infection, which entails an increased risk for the patient. In other countries, donors may be paid for giving blood. The fee is often low and those who really need the money may be part of a group of people where the risk of infection is higher.
“Many countries also struggle with the difficulties of determining the right blood group, screening for antibodies and being able to maintain the refrigerated chain when the blood is transported from donor to recipient”, says Martin L Olsson, professor of Transfusion Medicine at Lund University and President of the International Society of Blood Transfusion.
In Sweden, around three per cent of the population between 18 and 65 give blood at least once per year. The number has decreased somewhat in recent years, but healthcare has introduced stricter recommendations and become better at transfusing only when it is really needed, which means that nonetheless the blood is normally sufficient. Some 90 000 patients in Sweden received blood transfusions in 2018 – most are for patients over 65 receiving cancer treatment or for operations.
“Denmark previously had a high blood consumption per capita, but has reduced this through measures such as introducing stricter indications before transfusing, for example by not using two bags when perhaps one is enough and to reduce blood consumption in operations. Sweden is a little behind, but is also working more actively to reduce the use of blood.”
Even though the blood itself is donated, the healthcare apparatus associated with transfusions is expensive. The handling of a bag of fresh blood in Sweden costs just over SEK 1 000 and in the case of rare blood groups, which must be frozen, it is many times more expensive.
Sweden maintains a high safety standard regarding blood donations and transfusions. Many are scared of HIV infection via blood, but to date there have been no such cases of infection via blood transfusion since tests started in the 1980s. On the other hand, there have been isolated cases of an immunological reaction if a patient received the wrong blood group. A transfusion reaction may be mild, with only a slightly increased heart rate, or severe, causing the blood cells to break open. The most common reaction, however, is that the body quite simply transports the “defective” blood corpuscles to the spleen, where they are broken down.
“There are currently 365 different blood group variants and 38 blood group systems and it is vital to find the right blood for the patient. We often have patients who do not fit the template and then we carry on searching until we find the right blood donor. If we have a patient with a highly unusual blood group, we have to find a similarly unusual blood donor.”
Today, the focus is on developing DNA techniques that can provide blood group matching that is as perfect as possible. However, researchers around the world are experimenting with the possibility of creating universal blood that suits everyone. There are two different schools of thought concerning universal blood. One involves removing the antigens on the red blood corpuscles that determine your blood group. If you could “cut away” these enzymatically or chemically camouflage the cell by adding an artificial surface around it, it could, theoretically, remove the differences which lead to so many blood groups. The other school of thought is that in the long term we can replace a proportion of blood donations with cultivated blood from the laboratory. It is possible today to produce blood on a small scale from blood stem cells, or even from skin cells. The idea is that it is to act as “regular” blood, but production is currently extremely expensive.
“Regarding the rare blood groups, I think there may be a point in producing cultivated blood, as it is so seldom needed. But we are a long way from making universal blood a reality. Therefore, it is important that all those who are healthy go and give a gift that can save life. Because without blood, healthcare comes to a halt”, concludes Martin L Olsson.