Blood trail

A circuitous journey from donors to patients

By Nick Tabor, New Era Senior Staff Writer

Lisa Troutman will never find out how many people have her blood in their veins.

It’s easier to count the commemorative pins in her little plastic bag — 18, one for every gallon she’s donated — or her stack of T-shirts from blood drives.

Since she first donated in 1980, during high school in Indiana, she’s given 150 pints to the Western Kentucky Regional Blood Center. That’s two pints short of 19 gallons. She hopes to reach 20 gallons by 2014.

Troutman gets an emotional lift each time she donates. She knows it saves lives, she says.

She just doesn’t know exactly how. After staff members bag up and seal her blood, Troutman never sees it again.

On the other end, patients at six Western Kentucky hospitals routinely have blood Troutman donated pumped into their veins.

They never find out where it came from, and few ever wonder where it went in between.

Above all, blood distribution in Western Kentucky — as in most places in the U.S. — is reliable. Keeping it that way requires a complex system with dozens of participants performing different jobs.

Local interests

Dr. Frank Pitzer catalyzed the blood center’s creation in 1978, said Mike Stokes, laboratory director at Jennie Stuart Medical Center. Previously, most blood donated in this area went to the Red Cross facility in Nashville, Tenn.

Red Cross has a national scope. When Jennie Stuart needed blood, Red Cross couldn’t always supply it quickly, Stokes said.

The regional blood center protects the interests of local hospitals, Stokes said. As long as every county supplies its quota of blood each month, the blood center doesn’t charge for the blood it supplies in return. It collects a little more than $200 a pint, but only as a processing fee, said Janet Howard, the center’s director.

The center has nonprofit tax status and receives no outside funding. It occupies a small brick building in Owensboro, not far from the city’s major hospital. This hospital is the state’s largest west of Bowling Green, and thus the center’s biggest client, Stokes said.

The center serves six hospitals, from Breckinridge to Crittenden counties. Trover Health System in Madisonville does not participate because it has its own blood bank, said Sara Spencer, Trover’s spokeswoman.

Howard said the lab’s equipment is as high-tech as it is most anywhere in the U.S. It’s small for a blood center — processing roughly 15,000 units of blood a year, compared to 80,000 at the center in Lexington — and not many centers of its size handle their own testing. Outsourcing would save money, but local testing ensures the hospitals always can get blood quickly.

Sorting cells

In addition to its headquarters, the organization has a donation center on Virginia Street in Hopkinsville. It also has blood drives at grocery stores, churches, banks, schools, factories, hospitals and anywhere else donors will come.

Local staff members know Troutman, but most donors have to show their IDs when they come in. They fill out questionnaires about their medical histories, where they’ve traveled and their lifestyles.

Next a staff member pokes Troutman’s finger and a machine takes a hemoglobin count from the sample. Assuming the count is high enough, the staff member plugs a system of tubes and bags into her bloodstream, via a needle in her arm. While she lies on a chair, her blood is siphoned off into a small bag for testing and then fills the donation bag.

“Think of it like a cloverleaf — like an interstate system,” said Vicki Ellis, director of donor resources. “It’s all connected, but only the part that needs to be is sent to that bag.”

This is where Troutman’s role ends. She can drink a cup of juice and go home. Her body replaces the missing blood and seals the tiny hole in her vein.

Her blood is now a commodity.

It’s temporarily not human, sealed in plastic and branded with a barcode.

The blood center’s couriers drive it up the highway to Owensboro. At the lab, staff members put it in a blood centrifuge that spins blood packets like a washing machine. Red blood cells are pulled to the bottom because they are heavier. Plasma and platelets rise to the top.

The worker puts the red cells away for storage and scans the barcode into the computer system. Because plasma and platelets have a similar consistency, the machine spins them for a little while longer at a higher speed, and the worker stores these units as well.

Lab workers divide the test samples into four batches. From one, they test for the blood type and Rh factor, another for atypical antibodies and the rest for infectious diseases.

Once they know the blood type, workers organize the units into coolers and sort them by arrival date. Each bag’s barcode connects it to a section of data in the blood center’s vast database.

Layers of backup

Lab workers use a white board to keep track of what they have on hand. They stay in constant contact with hospitals, and the hospitals warn them in advance of major surgeries that will require large amounts of blood.

Red blood cells expire after 42 days, but most are shipped out within 48 hours, said Robbin Shively, the Hopkinsville center’s director of donor resources. Because the headquarters tries to keep 400 total units in stock, this leads to a massive turnover.

Hospitals place orders, and the blood center’s couriers fill them on a 24-hour cycle. Jennie Stuart also works with an independent courier for backup and uses a secondary courier when necessary, Stokes said.

In urgent situations, state troopers handle the delivery.

“So we got backup for our backup, to back up our backup,” Stokes said.

Jennie Stuart’s lab, in the basement of a hospital building, takes in five to 20 units of blood a day, Stokes said. Lab workers retest each unit.

Jennie Stuart’s lab typically keeps 90 to 100 blood units and 100 units of frozen plasma in its coolers. The hospital has never run out of blood, partially because it keeps different blood types around.

There are slim odds of every blood type being in high demand at once, Stokes said.

Jennie Stuart doctors place blood orders with their nurses. The lab has each order ready for pickup within 20 minutes, though it can rush orders when necessary.

Hospital workers transport the bags to patients’ rooms.

System strained

On June 12, Maria Minemyer bore her seventh child, a girl named Ella, at Jennie Stuart. Minemyer unexpectedly needed a cesarean section, and within 20 minutes after the birth, she started bleeding ceaselessly, she said.

Minemyer had a clotting disorder. Medical staff knocked her out with drugs and started operating.

Meanwhile, staff at the blood center looked up everyone in their donor database who had type A-negative blood. They asked these donors to come in and replenish their supply.

State troopers rushed the newly tested blood to Jennie Stuart, where nurses had at least six needles in Minemyer’s body to replenish the blood that continued to pour out of her.

Because they already had a donation campaign in Owensboro that week, they never ran out of A-negative.

After seven unconscious days, Minemyer awoke and learned she’d received five surgeries and 157 units of blood, counting the platelets that helped her blood resume clotting.

She feels almost as healthy and vigorous as before.

“It’s almost hard to comprehend that much blood,” she said Thursday. “I’m just thankful that there were people who donated and that it was available.”

Shively doubts few patients ever consider this.

“They just know, if they go to the hospital, there it is,” she said.