Blood Donation Gap and Pharmacists’ Role

It is important that people donate blood regularly, not only to save others’ lives, but also for their own health. Blood donations are particularly urgent for people who suffer from medical conditions or experience big incidences that make them in need for blood transfusions, such as those that have leukemia, aplastic anemia, or have been involved in vehicle accidents. The Canadian Blood Services, which is based in Ottawa, accepts year round blood donations. However, their policies are changing which might result in restricting or discouraging people to donate blood.
According to Global News, in an article published online on Oct 24, 2016, Canadian Blood Services has made changes to their guidelines and policies which made donating blood frequently harder for some people, which left a gap of an increased of number donors needed. Instead of an eight-week period between donations for women, it has been increased to 12 weeks effective December 10, 2016. For men, on the other hand, their hemoglobin levels should not be less than 130g/L, effective March 5, 20171, compared to 125g/L. Therefore, according to the vice-president of donor relations, more people will be needed to donate as fewer people can donate at a given time. The increase in time-frame between donations and stricter hemoglobin levels may pose a concern to Canadians who frequently donate blood as well as Canadians who need blood transfusion regularly. However, it is important to understand why these types of constraints might have taken place. Generally, blood donations do not cause loss of iron, though, frequent blood sample withdrawal can. For men, frequent blood donations can be minimum of three blood donations per year and for women more than two whole blood donations.2
Pharmacists, being one of the front-line health professionals in the community, can help people in maintaining adequate hemoglobin levels and iron stores (ferritin) through supplementations, awareness, education and counselling on medications. An iron-rich diet is a healthy choice, it might not be enough for patients with low iron stores, therefore, iron supplements might be needed. Pharmacists can play a role in advocating the use of iron supplements along with iron-rich food to their patients, especially for those who want to donate blood or donate on a regular basis. Community pharmacies may collaborate with family physicians, nurses or Canadian Blood Services to undergo finger stick detections or order labs, however, from a legal point of view and compensation-wise from the government in Ontario, this might not be feasible. Moreover, patients may not find the need for such testing as they can perform it elsewhere.
There are a number medications that can affect the blood and render a potential blood donor not being accepted to donate at Canadian Blood Services. Additionally, people can be deferred from donating due the medications they are taking or recently took, making them more aggravated by the fact that they cannot donate and the wait is extended. On the other hand, pharmacists can counsel these patients and help them be prepared for blood donation appointments by tapering off and removing any medications that can affect the blood.
Several factors contribute to a final decision for donation include: the type of transfusion the blood will be used for, the pharmacologic properties of the drugs, and drug interactions.3 For example, some medications may be teratogenic, hence the blood is unsuitable to be transfused to a pregnant woman.3 Additionally, over-the-counter medications, such as St. John’s Wort, may have traces in the blood that can interact with drugs the recipient is already getting.3 There are many examples regarding interacting medication, but the point here is that pharmacists can have a really active role in preventing deferrals and educate patients better on what to expect when donating blood. Good medication history gathering, MedCheck, and counseling can contribute to the safety of blood recipients and donors. The downside of this initiative and effort is that patients might not be interested or adhere to it and try to donate blood anyway. In addition to that, pharmacists may not be very enthusiastic to perform such extra tasks since they might not be remunerated for their time and effort. More research should be done on its feasibility and how practical it can be implemented as there is an increasingly need for blood donors but meanwhile, only one in 60 Canadians donate blood.1
All in all, the need for higher number of blood donors is increasing, and at the same, some restrictions are applied for the protection and well-being of Canadians. There are services available for patients to get their blood work, hemoglobin and ferritin levels to be tested, however, education and patient awareness might be lacking which can cause frustration among blood donors. Pharmacists can help the target audience by offering patient education and iron supplementation recommendations to maintain healthy iron stores for future blood donations.

Bibliography

1. Ramsay C. Change in Canadian Blood Services guidelines means increased need for donors | Globalnews.ca. Global News [Internet]. 2016 Oct 24 [cited 2016 Nov 28]. Available from: http://globalnews.ca/news/3022741/change-in-canadian-blood-services-guidelines-means-increased-need-for-donors/
2. Blood Donation and Iron Reserve [Internet]. 2014 [cited 2016 Nov 28]. Available from: https://www.hema-quebec.qc.ca/sang/savoir-plus/don-de-sang-et-reserve-de-fer.en.html
3. Panesar K. Assessing the Suitability of Blood Donors on Medication [Internet]. US Pharmacist. 2015 [cited 2016 Nov 28]. Available from: https://www.uspharmacist.com/article/assessing-the-suitability-of-blood-donors-on-medication

Standards and Interoperability: Part 2

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