ELIMINATING BLOOD SHORTAGES BY USING COMMON
SENSE: USING THE HEALTHY BLOOD OF THE ~12% OF AMERICANS WITH HIGH BLOOD IRON WHO
WOULD BE WILLING DONORS IF THEY KNEW THEIR BLOOD IRON WAS HIGH.
Victor D. Herbert, MD, JD, MACP. Mount Sinai-NYU Health System & Bronx V.A. Medical Center, Bronx, NY, 10468 United States.
In her August 20, 2001 Associated Press dispatch, "New System Tracks Blood Supply", L Neergaard reported that: 1) DHHS is signing up 29 "sentinel" hospitals across the U.S. to daily report how much blood they have in stock and how much they used in the past 24 hours, to provide a public Internet site "early warning system" of expected serious shortages; 2) Los Angeles blood banks are considering paying donors; 3) the banning of blood from Europe and persons who have been to Europe for six months in the past decade will cut blood donors by 9%; 4) the Red Cross is writing tens of thousands of donors, urging the less traveled to give blood more often; 5) hospitals are struggling to pay more for blood because the Red Cross in summer 2001 raised its prices to hospitals by 10 to 35%; 6) the National Blood Data Resource Center reports that in 1999 (the latest figures available) Americans donated 13.6 million usable units of blood and 12.4 million units were transfused. The shortage problem is solvable by common sense, which, as Mark Twain noted over a century ago, "is a wonderful thing. It's a pity its so rare." As V Herbert and M Spivack reported (J Investig Med 2001 (March): 49(2); 241A), FDA will grant to any blood bank a variance to treat healthy heterozygous (H) or homozygous hemochromatosis (HH) blood like any other donor blood, provided the requesting blood bank writes the FDA promising to treat the blood like any other donor blood, including not charging the donor for phlebotomy. Our Mount Sinai and Bronx VA blood banks did so (and subsequently so did a number of others) (listed on victorherbert.com). All blood banks should get these variances, and then use their PR resources to inform the public that ~12% of Americans (including ~20% of Celtic Americans and ~30% of African Americans) should, both as a public service and as a health measure, give blood, because they have high blood iron (H), (and ~0.5-1% have very high blood iron [HH]). All blood banks should measure blood iron on all donors, not only as a public service, but to stop harming the iron-overloaded by the too-routine practice of giving every donor iron supplement pills, to take 1 daily for a month, without measuring blood iron and phoning those with high iron to not only stop the supplements, but to stop all supplements containing iron and/or vitamin C. This information will make them regular repeat donors ("walking blood banks") as a health measure to not, as they might otherwise, gradually and insidiously develop one or more of the progressive tiredness, sterility, arthritis, diabetes, heart disease, liver disease, and cancer associated with iron overload (V Herbert. Clinical, biochemical, and molecular aspects of hemochromatosis. Proc. March 4-7, 2001 Ann Meet, SIMD [Soc. Inherited Metab. Disorders]). Tragically, in the U.S. today, iron overload, despite being the most common genetic variant, is rarely considered or tested for by healthcare providers, unless and until it has progressed to irreversible organ damage. There are ~200 million Americans age 17 or older. If the ~12% with moderately high iron gave 1 unit/year, that would be ~24 million units. If the ~0.5 to 1% who are HH (very high iron) gave an average of 6 units/year, that would be ~9 million units. Parenthetically, high iron blood is particularly desirable for that >70% of recipients who are iron-deficient from blood loss, and the frequent-phlebotomy blood from HH donors is especially desirable because of its high reticulocyte count and therefore longer half-life in the recipient's circulating blood.