How a nationwide blood shortage is affecting Oregon

The American Red Cross recently announced that blood donations are at a 20-year low. Along with the decline in donations, recent weather events disrupted planned donation drives. Angel Montes is the regional executive of donor services for the American Red Cross Cascades Region. He joins us to share more on what donations are looking like now and what this means in the Pacific Northwest. Claire Murphy is a pathologist and medical director of the Riverbend Hospital Laboratory Blood Bank. She also joins us to talk about what the shortage means at the hospital level.

This transcript was created by a computer and edited by a volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. The American Red Cross recently announced that blood donations are at a 20-year low, a combination of changes in donor behavior and a lot of weather disrupted blood drives. No state canceled more blood drives this month than Oregon. Angel Montes is the regional donor services executive for the American Red Cross’s Northwest region. Claire Murphy is a pathologist at Pathology Consultants, and the medical director of transfusion services at RiverBend Hospital. They both join us now to talk about both the reasons for this blood shortage and its repercussions. It’s great to have both of you on the show.

Angel Montes: Thank you, Dave.

Claire Murphy: Thanks for having us, Dave.

Miller: Angel first, the last time we spoke was almost exactly two years ago when you were grappling with what seems like a similar issue, but at a different time. We were really still right in the middle of the pandemic. What has changed in terms of the blood supply in the last two years?

Montes: I will say it’s not necessarily just in the last two years. The American Red Cross right now is facing an emergency blood shortage. The nation is facing the lowest amount of people donating blood in the last 20 years. The Red Cross needs to collect about an additional 8,000 blood donations each week over the next couple of weeks just to be able to recover from that.

There’s many reasons why we continue to struggle with having to go on nationwide appeals or local appeals. But because we’ve seen a degradation in the amount of donors that are donating on a consistent basis, every time we have weather impacts like what we had here in the Northwest…and not just here in the Northwest. Across the country, the Red Cross experienced a shortfall of 15,000 blood and platelet donations that were not able to be collected. That means we’re going to have to make up those units over the next several weeks in order to ensure that we continue to provide hospitals the blood products that they need for patients in need.

The way that we’ve been looking at this for a very long time is that as our loyal donor base ages, we haven’t necessarily had an increase in the donor base to replenish, as donors are no longer able to donate because they’re not healthy anymore. So it’s really a convergence of multiple reasons why we find ourselves in a situation like this. And when you have weather, that further impacts the ability to be able to collect, it further amplifies that pressure and that need to ensure that hospitals and their patients are receiving the blood products they need on a consistent basis.

Miller: In other words, say, 15 years ago when you had a more stable donor base, if the system had then been hit with the shock of January storms, you would have been able to weather it better because more people overall were putting their blood into the system.

Montes: Absolutely. It continues to amplify that way every time that we have weather related impacts, or other impacts that are out of our control, because we don’t have the same amount of donors that are donating blood on a consistent basis. It does make it very challenging.

For example, the Association for Advancement of Blood and Biotherapies, formally called the Association of American Blood Banks, put out a study. We used to have about 8 million blood donors that donated on a consistent basis. And in 2021, it was 6.6 million blood donors that gave each year through that study. So that’s what continues to impact the ability to make that product available, and makes it harder for us to be able to recover every single time that we have situations like this.

I can add a little bit more to this, specifically related to why we find ourselves where we are. Part of it is the aging donor base. If we don’t replenish or have the ability to have young donors that are able to donate blood on a consistent basis - and I say consistent, meaning every couple of months, every 56 days, at least once or twice a year, or up to 6 times a year if they choose to - then it makes it hard if we don’t have individuals who are no longer able to donate to be able to ensure the stability of the inventory.

The way that we engage communities, as we talked about the last time that I was on the call, has changed drastically as well. Slowly, the way people engage in communities was changing. After the COVID pandemic, people started working remotely. So you had big companies where we used to host blood drives on a consistent basis that no longer have staff in those buildings. So we can’t collect those units that we used to collect on a consistent basis, and we used to depend on. I said on the previous call that when we talk about high schools and colleges, during the pandemic a lot of that was more virtual learning. So we were unable to tap into that donor base as well. That added further concerns to an already fragile inventory that we have.

And one thing that is extremely important to note as well is that prior to the pandemic, there were some eligibility changes that were implemented, like the minimum hemoglobin thresholds. That actually resulted in more donor deferrals, especially among young donors 16 to 18 years of age. So when you implement processes like that related to eligibility, when you have individuals that are no longer going into their normal workplace, where they build that community, where they donate together as a family, and when you can’t tap into the schools like we used to in order to educate the future donor base, that’s what’s causing the issues that we have.

That’s why we had an appeal in September. And now we have an appeal in January. And then with the weather, it makes it even harder for us to be able to recover and ensure that the patients have the blood that they need.

Miller: I want to hear more from you about what the plan is going forward to get people to get used to donating blood. But as I noted, Claire Murphy is with us as well, the medical director of Transfusion Services at RiverBend Hospital in Bend. Claire Murphy, can you give us a sense for the various ways that blood products are used in hospitals?

Murphy: I can paint you a picture. So I’m a pathologist. Not a lot of people know what a pathologist is, but we make cancer diagnoses, like if you get a tissue biopsy or a skin biopsy. But we also run the laboratory, so we’re in charge of everything between chemistry, what your sugar level is, to the blood bank.

And the blood bank is important. Essentially the gift of blood is the gift of life. I walk into my lab and I look in the fridge and see exactly what we have for the day. We maintain our levels. We look at our par levels, our goal levels, and then we contact our blood suppliers for things that we need. We fill orders throughout the day. It could be outpatient infusion, so cancer patients that are coming in for platelets or a unit of blood because they’re undergoing chemotherapy, maybe their bone marrow isn’t working as well. Mothers on the labor and delivery floors that may be hemorrhaging, or managing some large car accident where multiple patients come in. So there’s a lot of things going on in the hospital that we have to supply for.

Miller: And you literally have a refrigerator, or maybe a freezer, somewhere there where it’s all stored?

Murphy: Yes. It’s a fancy fridge, we open the door like it’s a fridge. Heavily regulated by the FDA, looking at temperatures all the time. But blood has a shelf life. Like the milk in your fridge, red blood cells have about a 42 day shelf life. So we have to make sure that they’re not expiring, and use them before they expire. Platelets are more complicated. They like tender loving care and expire after five days. So platelets have shortage issues because we just can’t keep them for as long. And plasma we can freeze, so we don’t have as much issue with that.

Miller: The platelets that have only five days, that’s from the day that somebody donates blood? It gets checked out, as I understand, to make sure it’s safe for people to use, it gets processed. But you only have five days for that to go into somebody else’s bloodstream?

Murphy: Essentially, yes.

Miller: Does that mean that platelets have been hit hardest by the most recent storms?

Murphy: They can be. So when the ice storm hit Oregon, at one point we only had one platelet for the entire county, Lane County. And I got a phone call saying “we have a bleeder in the ICU, we have a possible trauma that might need a platelet in the ER, and we’re otherwise full, what if someone else needs a platelet? And we weren’t sure when we would get our next shipment from Bloodworks.

Miller: When you say “a platelet,” a bag of platelets that will then go on to the IV holder?

Murphy: Correct. We don’t split platelets, it’s just one bag.

Miller: How much is blood kept locally? If someone donates in the Portland area, how much of the stuff from their blood - the red blood cell cells, the plasma, the platelets - is going to stay in the Portland area?

Murphy: It depends. I don’t know the workings of Red Cross, but we use Bloodworks Northwest, which serves the entire Pacific Northwest. And if you are a donor locally and you go to the Lane Blood Center and you donate, all that gets processed in Seattle at their main processing lab into the different components. We split it into red blood cells, platelets, and plasma. So it has to come all the way back down to us. And there is sort of a surge storage area at Lane Blood Center to supply McKenzie Hospital, RiverBend Hospital, Florence, so that if we do have issues and our shelves are running low, they can supply us quickly. But otherwise they would have to be replenished by Seattle.

Miller: You graduated from medical school about a dozen years ago. Have you ever experienced anything like the current levels of blood products?

Murphy: So when I was a resident, I remember walking into a Bloodworks Northwest in Seattle. And essentially they used flagging systems, red, yellow, and green for the status of what components they had. And I remember so many days it was green. And the levels that we’re getting used to now are essentially in the red.

Miller: That you’re “getting used to.” So basically, what would have been seen as an alarming circumstance in the past is now just every day?

Murphy: Correct? Blood shortage has become the new normal. We have gotten more comfortable with having fewer red blood cells, especially O negatives on our shelves. And sometimes during the critical times of the shortages, Bloodworks will call us and say “you’re only getting ten O negatives today. Use them wisely.” Sometimes we have to do a special triage where I would get called by our medical technologists that run the blood bank and say “hey, these are our orders today. Who can we bump?”

Miller: Can you give us an example of the kinds of decisions that you have to make?

Murphy: Platelets are a good example because I get more calls on those since we’re just constantly having issues with that. I decided that we needed to use that platelet for a GI bleed in the ICU. And so we called the infusion center who also wanted the platelet to say “can you reschedule that patient for tomorrow if they’re stable and at home, we’ll get another platelet tomorrow for them but I need to give this to the bleeder right now.”

Miller: And what normally happens? Would the infusion center say “okay, we can wait”? What happens if they say “this patient needs it too”?

Murphy: Well essentially, if we get pushback, I will look up the patient and talk to their oncologist, usually the person referring, and talk to them about that. And so far we’ve been okay, I haven’t had any major issues yet. But we’re constantly at this edge because we don’t really have the buffer zone anymore that we used to 20 years ago.

Miller: And in that example, I guess by definition that the patient in the operating room, that’s an emergency. The cancer patient needs it soon, but maybe not exactly today. But if there’s a motorcycle accident or somebody else starts bleeding in another operating room, then it seems like it’s a true emergency.

Murphy: You nailed it. And so sometimes we get really creative. We’ll call McKenzie Hospital down the road and say “hey, can we have your platelet right now?” Or Lane Blood Center will maybe have one or two that they can send over emergently, and then they’ll call Seattle to bring something down. But as you say, it’s a scary place to be. And we’ve been there before, especially in the summer with multiple traumas. And we just sort of hope for the best. But it is scary, and that’s why we need donors to donate regularly.

Miller: Angel, I want to go back to you just to talk about the enormous drop in regular donors, which it seems are some of the people that you rely on the most. This is not to trivialize public radio fund drives in comparison to people on operating tables, but it does sound like we both rely on people who make it a habit of giving. And what you’ve said is that that number has gone down. And you mentioned a lot of societal shifts that are a part of that, a lot of them pandemic related - fewer people going into the office, fewer people giving in school.

I’m curious if you also see a generational shift? You talked about your donors aging, and this wouldn’t be a problem if younger people were replacing them. Why do you think they aren’t?

Montes: That’s a really good question. And just to throw a stat out there, we actually had 260,000 young donors aged 18-24 that gave blood to the Red Cross in 2021. So that’s less than half of what we saw in 2019. The inability for us to be able to tap into that market, be able to educate about the importance of blood donations and platelet donations on a consistent basis…

Miller: If I could interrupt, that to me does seem like that’s potentially good news, because it’s hard to imagine anything being responsible for a drop that big between 2019 and 2021 besides the pandemic. In other words, that doesn’t seem like evidence that young people these days just don’t care. It seems more that the pandemic was such a shock to people’s lives that it changed their behavior in profound ways.

Montes: Absolutely. And I would never say that young people don’t care. I know that there’s a lot of youth that are out there that want to support, they want to build a community, they want to make sure that patients have the blood that they need. We are seeing a steady return, a steady increase. But it’s still not to the pre-COVID levels that we need in order to ensure the stability there. We do anticipate that as we continue to work with high schools, with colleges, with universities, and are able to host blood drives on campus, that it’s going to provide us the opportunity to educate the youth on the importance of blood donations. That education is important. Sometimes people are scared to donate blood if they’re seeing that they have to have a needle inserted into their arm. Understanding why the product is needed, as Dr. Claire Murphy has been stating.

In terms of the demographics, with retired individuals, 65 or older, we have seen an increase since the pandemic in overall donations. And part of that could be that as you get older, you get to know someone that has received blood, you yourself could have experienced a traumatic incident where you’re receiving blood as well. So there’s a higher level of potential commitment because you’ve experienced that pain, that you maybe lost somebody or the fact that you needed blood. So that’s why the educational piece with youth is so important. It’s not that we have a generation that doesn’t want to give. It’s that we need to ensure that we have the opportunity to be on campus to educate, to support, and ensure that youth feel like they are the future of the blood donor program that’s going to ensure that hospitals and patients have the blood that they need.

Miller: Claire Murphy, if you were talking directly to people who have never given blood before or got out of the habit of it, what would you tell them?

Murphy: I would tell them as I said before, the gift of blood is the gift of life. Think of people who are in the hospital right now, maybe some relative or a baby that was born that maybe needs blood emergently. There are people who need you. And just 15-20 minutes of your time at a local blood center every 56 days can mean someone survived a traumatic event in the hospital.

Miller: Claire Murphy and Angel Montes, thanks very much.

Montes: Thank you, Dave.

Miller: Clair Murphy is a pathologist at Pathology Consultants and the medical director of transfusion services at RiverBend Hospital. Angel Montes is the regional donor services executive for the American Red Cross’ Northwest Region.

Contact “Think Out Loud®”

If you’d like to comment on any of the topics in this show or suggest a topic of your own, please get in touch with us on Facebook, send an email to thinkoutloud@opb.org, or you can leave a voicemail for us at 503-293-1983. The call-in phone number during the noon hour is 888-665-5865.