BLOOD LETTING OR PHLEBOTOMY, was one of the most common forms

of medical therapy. So pervasive was the practice that the term ‘leech’, from the use of
these animals to suck out a patient's blood, was a synonym for medical practitioner in
England from the time of the Anglo-Saxons. Leeching, cupping — the use of a horn or a
vessel to draw blood to the skin's surface, and venesection — the opening of a vein, were
in medical use well into the twentieth century and have not entirely disappeared from
present-day practice.

Until William Harvey's discovery of circulation in 1628, blood was thought to be

produced continually in the liver and sent around the body by a sort of boiling, fuelled by
heat generated from the digestion of food. A normal body nourished itself from this
blood, excreting waste material in the form of urine, faeces, sweat, and mucus.
Haemorrhoidal and menstrual blood were also considered normal forms of excrement,
eliminating from the body the ‘dregs’ of blood — clotted, dark, and contaminated by
black bile or melancholy, one of the four humours. Certain kinds of ‘blood lettings’ were
thus considered quite normal, and were the body's way of ridding itself of waste products.

Blood letting as a form of medical therapy arose from a belief that fever and
inflammation, characterized by redness, swelling, heat, and a quick pulse, were the result
of too much blood, which had to be eliminated. The most usual way of accomplishing
this was to open a vein, usually the basilic vein at the front of the elbow. Alternatively,
blood was drawn to the skin's surface, sometimes by applying suction to an animal's horn
with a small hole cut in the tip, or by placing a heated glass cup on the skin. When the air
inside the cup cooled, it contracted and drew blood to the skin's surface. This was called
dry cupping. Commonly, the bleeder would make small cuts in the skin's surface with a
lancet or by using a small box with trigger-loaded knives inside, before applying the cup,
which would then fill with blood. Another popular method was to apply leeches, ideally
selected with great care for their cleanliness and fitness to the task, which were allowed
to drop off after drawing their fill. Three or four were usually recommended, but some
nineteenth-century physicians advised 50 at once, a blood letting of nearly vampiric
proportions.

One of the purposes of blood letting was to reduce fever, which was indicated by a drop
in the pulse after phlebotomy was accomplished. Another was to aid nature, that is to
help the body rid itself of ‘peccant’ or harmful matter that was causing inflammation at a
particular site. Medieval Islamic physicians advocated what is generally called
‘revulsive’ bleeding — blood letting at a place remote from the site of inflammation, in
order to draw the peccant matter back into the body where it could be ‘digested’
normally. Followers of the ancient Greek texts attributed to Hippocrates, like the
Frenchman Pierre Brissot (1478-1522) and the Englishman Thomas Sydenham (1624-
89), advocated the opposite — a ‘derivative’ method in which the blood and peccant
matter were evacuated close to the site of the inflammation and on the same side of the
body. The latter method was in common use after the end of the medieval period.

Medieval medical thinkers often commented on the attraction of the moon both on the
tides and on the flow of blood in the body. Many also seem to have associated increased
production of blood with the rise of sap in trees during early springtime. Both these
beliefs affected the way blood was let. Barbers, surgeons, and the keepers of bath houses,
all of whom bled as part of the practice of their trade, were warned not to open veins
when the moon caused a high tide, lest too much blood be released. They also typically
let blood in the springtime from people who were not ill as a kind of ‘spring tonic’.

The discovery of the circulation of the blood only increased the popularity of the practice.
By the end of the eighteenth century, blood letting was depicted in novels being
performed by lay people as a kind of life-saving ‘first aid’ to relieve ‘congestion’ caused
by fainting and as the result of accidents. Medical texts before World War II still
advocated phlebotomy, either by leeches or by venesection, to ‘lower arterial tension’ and
to ‘relieve right side stagnation’ of blood in the heart. Nowadays blood letting seems to
us a relic of a former age. Its only common use is to reduce the damaging effects of an
excess of red blood cells in cases of polycythaemia vera. Recently, however, the use of
leeches has returned, to remove blood from capillaries after delicate surgery.

BLOOD DONATION

A blood donation occurs when a healthy person voluntarily has blood drawn and used for
transfusions or made into medications by a process called fractionation.

In the developed world, most blood donors are unpaid volunteers who give blood for a
community supply. In poorer countries, established supplies are limited and donors
usually give blood when family or friends need a transfusion. Many donors donate as an
act of charity, but some are paid and in some cases there are incentives other than money
such as paid time off from work. A donor can also have blood drawn for their own future
use. Donating is relatively safe, but some donors have bruising where the needle is
inserted or may feel faint.

Types of donation

Blood donations are divided into groups based on who will receive the collected blood.
An allogeneic (also called homologous) donation is when a donor gives blood for
storage at a blood bank for transfusion to an unknown recipient. A directed
donation is when a person, often a family member, donates blood for transfusion
to a specific individual. Directed donations are relatively rare. A replacement
donor donation is a hybrid of the two and is common in developing countries such
as Ghana. In this case, a friend or family member of the recipient donates blood to
replace the stored blood used in a transfusion, ensuring a consistent supply. When a
person has blood stored that will be transfused back to the donor at a later date,
usually after surgery, that is called an autologous donation. Blood that is used to
make medications can be made from allogeneic donations or from donations
exclusively used for manufacturing.
The actual process varies according to the laws of the country, and recommendations to
donors vary according to the collecting organization.[9][10][11] The World Health
Organization gives recommendations for blood donation policies,[12] but in developing
countries many of these are not followed. For example, the recommended testing requires
laboratory facilities, trained staff, and specialized reagents, all of which may not be
available or too expensive in developing countries.

An event where donors come to give allogeneic blood is sometimes called a blood drive
or a blood donor session. These can occur at a blood bank but they are often set up at a
location in the community such as a shopping center, workplace, school, or house of
worship.

Screening

Donors are typically required to give consent for the process and this requirement means
that minors cannot donate without permission from a parent or guardian. In some
countries, answers are associated with the donor's blood, but not name, to provide
anonymity; in others, such as the United States, names are kept to create lists of ineligible
donors.[16] If a potential donor does not meet these criteria, they are deferred. This term is
used because many donors who are ineligible may be allowed to donate later.

The donor's race or ethnic background is sometimes important since certain blood types,
especially rare ones, are more common in certain ethnic groups. Historically, donors were
segregated or excluded on race, religion, or ethnicity, but this is no longer a standard
practice.

Donors are screened for health risks that might make the donation unsafe for the
recipient. Some of these restrictions are controversial, such as restricting donations from
men who have sex with men for HIV risk.[19] Autologous donors are not always screened
for recipient safety problems since the donor is the only person who will receive the
blood. Donors are also asked about medications such as dutasteride since they can be
dangerous to a pregnant woman receiving the blood.

Donors are examined for signs and symptoms of diseases that can be transmitted in a
blood transfusion, such as HIV, malaria, and viral hepatitis. Screening may extend to
questions about risk factors for various diseases, such as travel to countries at risk for
malaria or variant Creutzfeldt-Jakob Disease (vCJD). These questions vary from country
to country. For example, while Québec, Poland, and the US may defer donors who lived
in the United Kingdom for risk of vCJD, donors in the United Kingdom are only
restricted for vCJD risk if they have had a blood transfusion in the United Kingdom.

[edit] Donor safety

The donor is also examined and asked specific questions about their medical history to
make sure that donating blood isn't hazardous to their health. The donor's hematocrit or
hemoglobin level is tested to make sure that the loss of blood will not make them anemic,
and this check is the most common reason that a donor is ineligible. Pulse, blood
pressure, and body temperature are also evaluated. Elderly donors are sometimes also
deferred on age alone because of health concerns. The safety of donating blood during
pregnancy has not been studied thoroughly and pregnant women are usually deferred.

Blood testing

The donor's blood type must be determined if the blood will be used for transfusions. The
collecting agency usually identifies whether the blood is type A, B, AB, or O and the
donor's Rh (D) type and will screen for antibodies to less common antigens. More testing,
including a crossmatch, is usually done before a transfusion. Group O is often cited as the
"universal donor"but this only refers to red cell transfusions. For plasma transfusions the
system is reversed and AB is the universal donor type.

Most blood is tested for diseases, including some STDs. The tests used are high-
sensitivity screening tests and no actual diagnosis is made. Some of the test results are
later found to be false positives using more specific testing. False negatives are rare, but
donors are discouraged from using blood donation for the purpose of anonymous STD
screening because a false negative could mean a contaminated unit. The blood is usually
discarded if these tests are positive, but there are some exceptions, such as autologous
donations. The donor is generally notified of the test result.

Donated blood is tested by many methods, but the core tests recommended by the World
Health Organization are these four:

• Hepatitis B Surface Antigen

• Antibody to Hepatitis C
• Antibody to HIV, usually subtypes 1 and 2
• Serologic test for Syphilis

The WHO reported in 2006 that 56 out of 124 countries surveyed did not use these basic
tests on all blood donations.[13]

A variety of other tests for transfusion transmitted infections are often used based on
local requirements. Additional testing is expensive, and in some cases the tests are not
implemented because of the cost. These additional tests include other infectious diseases
such as West Nile Virus. Sometimes multiple tests are used for a single disease to cover
the limitations of each test. For example, the HIV antibody test will not detect a recently
infected donor, so some blood banks use a p24 antigen or HIV nucleic acid test in
addition to the basic antibody test to detect infected donors during that period.
Cytomegalovirus is a special case in donor testing in that many donors will test positive
for it. The virus is not a hazard to a healthy recipient, but it can harm infants and other
recipients with weak immune systems.
Obtaining the blood.

There are two main methods of obtaining blood from a donor. The most frequent is
simply to take the blood from a vein as whole blood. This blood is typically separated
into parts, usually red blood cells and plasma, since most recipients need only a specific
component for transfusions. The other method is to draw blood from the donor, separate
it using a centrifuge or a filter, store the desired part, and return the rest to the donor. This
process is called apheresis, and it is often done with a machine specifically designed for
this purpose.

For direct transfusions a vein can be used but the blood may be taken from an artery
instead. In this case, the blood is not stored, but is pumped directly from the donor into
the recipient. This was an early method for blood transfusion and is rarely used in modern
practice. It was phased out during World War II because of problems with logistics, and
doctors returning from treating wounded soldiers set up banks for stored blood when they
returned to civilian life.

Site preparation and drawing blood

The blood is drawn from a large arm vein close to the skin, usually the median cubital
vein on the inside of the elbow. The skin over the blood vessel is cleaned with an
antiseptic such as iodine or chlorhexidine to prevent skin bacteria from contaminating the
collected blood and also to prevent infections where the needle pierced the donor's skin.

A large needle (16 to 17 gauge) is used to minimize shearing forces that may physically
damage red blood cells as they flow through the needle. A tourniquet is sometimes
wrapped around the upper arm to increase the pressure of the blood in the arm veins and
speed up the process. The donor may also be prompted to hold an object and squeeze it
repeatedly to increase the blood flow through the vein.

Recovery and time between donations

Donors are usually kept at the donation site for 10–15 minutes after donating since most
adverse reactions take place during or immediately after the donation. Blood centers
typically provide light refreshments or a lunch allowance to help the donor recover. The
needle site is covered with a bandage and the donor is directed to keep the bandage on for
several hours.

Donated plasma is replaced after 2–3 days. Red blood cells are replaced by bone marrow
into the circulatory system at a slower rate, on average 36 days in healthy adult males. In
that study, the range was 20 to 59 days for recovery. These replacement rates are the
basis of how frequently a donor can give blood.
 RED CROSS BLOOD DONATION

About
The Blood Program of the Philippines operates in accordance with the provisions of the
National Blood Services Act of 1994 or Republic Act 7719. In tripartite cooperation with
the Department of Health and the Philippine Blood Coordination Council, the Philippine
Red Cross (PRC) is one of the key organizations tasked to provide safe blood to the
country through its active role in advocacy, promotion of voluntary blood donation,
donor retention and care and the operation of a network of 74 Blood Service Facilities all
over the country.

Profile
The PRC gives comprehensive blood services which includes donor recruitment,
collection and storage of blood, blood testing , processing and supply to the hospitals in
accordance with the provisions of National Blood Services Act 1994 or Republic Act
7719.

Donor Recruitment
In its continuous efforts to serve the ever increasing demand for blood in the country, the
PRC Blood Services conducts voluntary blood donor education and recruitment to
communities, different companies, organizations and schools nationwide.

These donor recruitment sessions aims to intensify the campaign for the important role of
Voluntary Unpaid Donors in sustaining National Blood Requirement and the specific
qualifications to be a voluntary blood donor.

Blood Collection
In 2007, PRC Blood Service Facilities and Blood Collecting Units had a total collection
of 187,352 bags. This accounts for about 24% increase from 2006's blood collection of
150,641 units. The National Blood Center together with 3 Regional Blood Centers assist
and support other PRC Chapters in blood collection in terms of manpower and campaign
materials when necessary.

Blood Testing
To ensure that the blood we collected are safe to transfuse to the patients, we perform
blood tests for Malaria, Syphilis, Hepatitis B & C, Human Immunodeficiency Virus and
Blood typing (both ABO and Rh typing). All blood units found reactive or positive in any
of the above mentioned disease screening tests are quarantined and retested. Blood units
found reactive twice are labeled 'not for transfusion-for confirmatory testing' quarantined
and then sent within 48 hours to appropriate center for confirmatory testing.

Blood Component Processing

Some of the PRC Blood Centers have facility to divide blood into components using
special equipment called refrigerated centrifuges. Thus, when you donate blood, you help
save 3 lives.

Voluntary Blood Donor Recognition

We have instituted different recognition awards to sincerely acknowledge and thank the
individuals and corporate groups that untiringly help us to attain our mission. Blood
Galloners Pin and Certificates, Medals and Plaques of Appreciation are our small tokens
we give during our Annual Blood Donors Recognition Ceremony.

Sustainability
The costs of managing the comprehensive blood services are raised through different
sources, main of which are:

- Cost contribution by the consumers

- Cash donation from the government (national lottery and local government units)
- Some kits and reagents from the Department of Health and local government units

While these resources are currently adequate to operate the blood services, resources
requirements will increase significantly to implement a goal of completely phasing out
replacement donation by this year.

Rh Negative
Rh is another blood group system aside from ABO. We are familiar with the ABO Blood
Group System wherein blood types would be; A, B, O, AB. In Rh Blood Group System,
you will be typed as Rh positive/ (+) if you have the Rh antigen, and Rh negative/(-) if
none.

In the Philippines, approximately <1% of the population are Rh negative and >99% are
Rh positive. Because of inadequacy of Rh negative blood, the Registry was established in
1999.

The Registry
The National Registry of Rh Negative and Other Rare Blood Types has been established
to gather all individuals with rare blood types in the country. A joint project of the Rotary
Club of Pasig, the Department of Health - National Voluntary Blood Services Program,
the Philippine Red Cross, and the Philippine Association of Rh Negative and Other Rare
Blood Types, the Registry aims to make Rh negative blood readily and efficiently
available.

How to avail Rh negative blood:

1. Fax the blood request to 02-521-3929 with the following data: (request with
incomplete data will not be honored.)
a. Name
b. Age/Gender
c. Citizenship
d. Diagnosis
e. Blood Type
f. No. of Units/Component of Blood
g. Contact person/number/address
h. Requesting physician's signature

2. Confirm at 02-521-3929 if they receive the blood request. As soon as the registry
receives the blood request, we will look for possible blood donors.

3. Wait for the proper instruction/advice on the availability of blood.

4. To follow-up your request, you may contact 02-521-3929 or 0918-918-6531.

 BLOOD DONATION FAQ’s

1.What happens to my donated blood?

Each unit of blood collected will be examined for 5 transfusion transmissible infectious
diseases (HIV, Malaria, Syphilis, Hepatitis B and C) before it is transfused to patients.

2. Is it safe to give blood?

Yes. The Red Cross ensures donating blood is a safe opportunity to give the gift of life.
Each needle used in the procedure is sterile and is disposed of after a single use. It is
important that all blood donors are in good health, are well-rested and have eaten prior to
donating.

3. When can we donate blood?

A healthy person may donate blood every 3 months.

4. Where can I donate blood?

You, your family and friends may come and visit the PRC National Blood Center and
Regional Blood Center or any Red Cross Blood Service Facility nearest you. You may
click the Chapters link for the location of the different PRC Blood Service facilities.

5. Can a person who has tattoo donate blood?

Provided the tattooing procedure was done in a sterile manner, he/she may donate 1 year
after the procedure. This is the same with ear piercing, acupuncture and other procedures
involving needles.

6.Are the health history questions necessary every time I donate?

To ensure the safest possible blood supply, all donors must be asked all the screening
questions at each donation. The World Health Organization and the Department of Health
require that all blood centers conform to this practice.

7.What does the term "donor deferral" mean?

Individuals disqualified from donating blood are known as "deferred" donors. A
prospective donor maybe deferred at any point during the collection and testing process.
Whether or not a person is deferred temporarily or permanently will depend on the
specific reason for disqualification (eg. a person maybe deferred temporarily because of
anemia, a condition that is usually reversible). If a person is to be deferred, his or her
name is entered into a list of deferred donors maintained by the blood center, often
known as the "deferral registry".

If a deferred donor attempts to give blood before the end of the deferral period, the donor
will not be accepted for the donation. Once the reason for the deferral no longer exists
and the temporary deferral period has lapsed, the donor may return the blood bank and be
re-entered into the system.
8. If I was deferred once before, am I still ineligible to donate?
If your deferral is of a permanent nature, you will be informed. Otherwise, the deferral
time depends on the reason for deferral. Prior to each donation, you will be given a mini-
physical and medical interview. At that time, it will be determined if you are eligible to
donate blood on that particular day.

9. What are some of the reasons for permanent deferral?

-Anyone who have Hepatitis B and C infections.
-Anyone who have HIV infection.
-Anyone who had sexual contact with a person known to have HIV.
-Have risk factors for HIV infection (having multiple sex partners, patronizing sex
workers).
-Have previous and current history of cancer.
-Suffering serious chronic illness (heart and lung diseases).

10. Can a person who just had his/her tooth extracted donate?
He/she will be temporarily deferred for 1 year.

11. If I just received a flue shot, can I donate blood?

Yes. There is no waiting period to donate after receiving a flu shot.

12. If I have a cold or flu, can I donate blood?

In order to donate, you must be in generally good health (symptom-free) and recommend
that you are feeling well.

13.Can I still donate if I have high blood pressure?

Yes, if your blood pressure is under control and within the limits set in the donation
guidelines.

14. What if I'm taking aspirin or medication prescribed by my doctor?

Aspirin and Ibuprofen will not affect a whole blood donation. Aspherisis platelet donors,
however, must not take aspirin or aspirin products 36 hours prior to donation. Many other
medications are acceptable. It is recommended that you call the blood center ahead of
time to inquire about any medications you are taking.

15. How long does it take to donate blood?

The whole process of donating blood will take an average of 25 minutes only.

16. What if I have anemia?

You cannot give blood if you have anemia. However, this can often be a temporary
condition. Your hemoglobin will be tested before you donate to make sure it is at an
acceptable level.

17. Will I put on weight or lose weight after blood donation?

No. All you put on is the feeling of satisfaction of having helped someone.
18. What other types of tests are done on the blood?
Your blood is tested to determine your blood type classified as A, B, AB and O - and
your Rh factor. The Rh factor refers to the presence or absence of a specific antigen, a
substance capable of stimulating an immune response, in the blood. So you're either Rh
positive or Rh negative, meaning you carry the antigen or you don't. This information is
important to know because your blood type and Rh factor must be compatible with the
person receiving your blood.

19. What is the most common blood type?

The approximate distribution of blood types in the Philippine population is as follows.
Distribution maybe different for specific racial and ethnic groups:

O Rh positive - 44-46%
A Rh positive - 22-23%
B Rh positive - 24-25%
AB positive - 4-6%
Rh negative group - Less than 1%

20. What fees are associated with blood?

While the donated blood is free, there are significant costs associated with collecting,
testing, preparing components, labeling, and storing blood; recruiting and educating
donors; and quality assurance. As a result, processing fees are charged to recover costs.
Blood processing fees collected are in conformance with the stipulated allowable fees as
mandated by the Department of Health.

21. What can you do if you aren't eligible to donate?

While a given individual maybe unable to donate, he or she maybe able to recruit a
suitable donor. PRC Blood Banks are always in need of volunteers to assist at blood
donations or to organize mobile blood drives. In addition, monetary donations thru the
Blood Samaritan Project of the Red Cross are always welcome to help ensure that blood
banks can continue to provide safe blood to those in need especially to indigent patients.

22. How can I host a mobile blood donation activity at my work, school, church or
community?
Use the Chapters Directory to find the blood donation center nearest you, our Blood
Service Representatives will assist and gladly accommodate all your inquiries.
DOs and DON'Ts of blood donation
Let others benefit from your good health. Do donate blood if ...
you are between age group of 18-60 years.
your weight is 45 kgs or more.
your haemoglobin is 12.5 gm% minimum.
your last blood donation was 3 months earlier.
you are healthy and have not suffered from malaria, typhoid or other transmissible
disease in the recent past.
There are many, many people who meet these parameters of health and fitness!

Blood Donation Dos

• Eat foods high in iron a few hours before donating to ensure that your iron count is high.
These include whole grains, red meat, eggs, and dark, leafy vegetables such as spinach.
The vitamin C in orange juice also helps increase iron absorption.

• Having a light-hearted conversation with the person administering your donation can help
to distract you. Pinch yourself while the needle is going in, and have something to chew
on, such as gum, to take your mind off the needle. Recite something from memory, or
sing a song while the blood is being drawn. Before you know it, the process will be over.

• Have a snack after the donation. All centers provide fruit juice and sugary snacks to get
your blood sugar back up to a normal level. Be sure to have the juice and cookies, and
rest in the center while you eat.

• Make sure your next meal is high in protein. Also remember to consume fruits and
vegetables and drink lots of water, as the combination will help your body to create new
blood right away.

• Rest for the remainder of the day. Don't plan a trip to the gym or to the dance club later.
Instead, try to rest as you would if you were trying to get over a bad cold. Read, see a
movie, or work on the computer, but don't push yourself too hard.

Do abide by our rules - be truthful about your health status!

We ensure the health of blood, before we take it, as well as after it is collected. Firstly, the donor
is expected to be honest about his or her health history and current condition. Secondly, collected
blood is tested for venereal diseases, hepatitis B & C and AIDS.

You have to be healthy to give 'safe blood'

Do not donate blood if you have any of these conditions

cold / fever in the past 1 week.

under treatment with antibiotics or any other medication.
cardiac problems, hypertension, epilepsy, diabetes (on insulin therapy), history of
cancer, chronic kidney or liver disease, bleeding tendencies, venereal disease etc.
 major surgery in the last 6 months.
vaccination in the last 24 hours.
had a miscarriage in the last 6 months or have been pregnant / lactating in the last one
year.
had fainting attacks during last donation.
have regularly received treatment with blood products.
shared a needle to inject drugs/ have history of drug addiction.
had sexual relations with different partners or with a high risk individual.
been tested positive for antibodies to HIV.

Blood Donation Don'ts

• Don't consume caffeinated beverages before donating. While it's important to drink
plenty of fluids beforehand, caffeinated drinks are diuretics, which will make the body
expel more water. Stick with water instead.

• Don't eat fatty foods prior to the process. The fat in fast foods, for example, can interfere
with the blood screening done after the donation, causing the blood to be disposed of, and
you don't want your donation to go to waste.

• Don't donate on an empty stomach. Eat a good breakfast to keep your blood sugar stable
and to ward off lightheadedness. Don't eat too close to donation time, however, as this
may result in an upset stomach.

• Don't donate if you weigh less than 110 pounds or if you're younger than 17 years of age.

• Don't drive yourself home from the donation center. Afterward, the body often feels
weak, and you may become faint or even fall asleep while driving. Plan to visit the center
with a friend or relative so they can help after the process is over.
Father Saturnino Urios University
Nursing Program
Butuan City

BLOOD LETTING

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