Difficult blood donor choices: dance, feast or donate blood?

DOI: 10.5581/1516-8484.20130073 An article in this issue of the Revista Brasileira de Hematologia e Hemoterapia addresses one of the most difficult management challenges in blood banking: balancing supply and demand of blood and blood products collected from volunteer, non-remunerated donors (1). It looks specifically at the distribution of weekly blood collections at three major Brazilian blood centers participating in the Retrovirus Epidemiology Donor Study-II (REDS-II) research program supported by the National Heart, Lung and Blood Institute of the U.S. National Institutes of Health from January 2007 to December 2010(2). These centers are the Pro-Sangue in the State of São Paulo, Hemominas in the State of Minas Gerais and Hemope in the State of Pernambuco. The authors observed seasonal declines in the number of donations during the holiday weeks of Carnival and Christmas with consequent shortages of blood components available for transfusion in each of the analyzed years. The decline during Carnival was more evident in Recife and Belo Horizonte than in São Paulo but the three blood centers experienced shortages during the Christmas week. The authors recommend attention and preparation for these predicted shortages in their collection planning and donor campaigns. There are many factors that need to be considered when addressing seasonal variations in blood donor behavior. First, holidays are predictable and occur every year, differently from other major disasters, flu epidemics or competing events such as mass vaccination campaigns (as mentioned by the authors) that may affect supply and demand. Second, blood components have a limited shelf life. Red blood cells can be stored for up to 42 days and platelets for only 5 days. Plasma can be frozen for up to a year. Third, other holidays occur during the year including summer school vacations that can also interfere with blood collections. These phenomena are not unique to Brazil or to blood collections and have been addressed by prior REDS studies in Brazil(2) and in the United States(3). Temporal variations have also been noted when weekdays and weekends were analyzed in Hong Kong(4). For many years, blood bankers have relied on public campaigns and urgent appeals in order to increase the supply of whole blood and components in times of shortage or as an attempt to prevent shortages. These campaigns often emphasize the dangers associated with limited supplies of this precious liquid. “Lives may be lost!”, “What will happen if there is an accident and there is no blood on the hospital shelves?” Unfortunately, these appeals not infrequently fall on deaf years. People have their priorities, and despite being committed to helping other people, they do have a life, family and obligations. These campaigns create anxiety in donors and in the general population, and reinforce donation behaviors that are not ideal and unlikely to smooth the shape of the curve of blood donations throughout the year. The following are some of the consequences of blood appeals and campaigns that address specific shortages. They