The Stories Blood Can Tell

History: The questionnaire given to potential blood donors reflects changes in the field of medicine and in the world around us.

Medicine & Science

February 17, 2003|By Scott Shane | Scott Shane,SUN STAFF

Give the gift of life, the public service ads say. It sounds so simple.

But donating blood these days means negotiating a questionnaire that rivals the income tax return in its complexity, uses terms such as "babesiosis" and "human pituitary derived hormone," and pries into the donor's intimate sexual secrets.

Since donor questionnaires were introduced 50 years ago, they have grown longer and more tangled as medical experts work to keep dangerous germs out of the nation's blood supply. The form has become a kind of mini-history of medicine, reflecting emerging disease threats, new medications, changing sexual practices and increased use of illicit drugs.

"This donor questionnaire is kind of a patchwork," says Dr. Kenrad E. Nelson, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health and chairman of a Food and Drug Administration panel on blood. "People have added questions over the years but rarely taken them off."

In fact, the form has grown so formidable that the FDA, which regulates the blood industry, asked blood banks three years ago to devise a simpler, easier-to-understand questionnaire. The improved version is to be introduced nationwide this year.

"Some of the questions I thought, frankly, were kind of ridiculous," says Dr. Joy L. Fridey, a blood specialist at a California hospital who led the task force charged with redesigning the questionnaire. She singles out, for example: "Are you a female who, in the past 12 months, has had sex with a male who has had sex, even once, with another male since 1977?"

"Even someone who reads Sophocles and The Wall Street Journal every day would have trouble teasing that apart," Fridey says.

Yet the redesigned questionnaire, although far easier to follow than the current forms, is even longer - 48 questions, compared with about 40 now. And it will still test a donor's memory.

"We ask you to know your sexual history for 26 years," says Dr. Edward P. Scott, who runs Lifeblood, a network of blood donation centers based in Memphis, Tenn. "You need to know your partners' sexual history for 26 years. And you need to know your travel history for 23 years."

What the donor sees, however, is only the tip of the paperwork iceberg. To back up the one-page form, every blood bank has a pile of charts to guide screeners on whom to exclude.

Donor just returned from Azerbaijan? Malaria is a risk only if he or she visited the rural lowlands.

Donor recently had her ears pierced? No problem, if it was done by a licensed business with a disposable needle. Otherwise, she can't donate for 12 months because of the risk of spreading hepatitis.

But all that paperwork is for a noble cause. About 12 million Americans give blood each year, and about 20 million receive transfusions of whole blood or blood products, Nelson says. Many would die without the help.

The growth of the donor questionnaire reflects the emergence of new infectious disease threats, first HIV and recently the mad cow variant of Creutzfeldt-Jakob disease. Global travel and immigration have made tropical ills such as malaria and rare disorders such as Chagas' disease a real concern.

Social changes such as greater sexual promiscuity and the use of injected drugs also have shaped many questions. And new medications and vaccines create potential risks for blood recipients.

Yet excluding too many donors could needlessly shrink the blood supply.

For example, Fridey wonders how many people who ate British beef really have been infected with the prions that cause mad cow disease.

"My personal opinion is the risk is very, very small," she says. But she can't be certain: "Is it possible that [by excluding people who lived in England] we averted a terrible epidemic? Or did we defer a lot of donors needlessly and add to an ever-worsening blood shortage?"

More change is ahead for blood donors. The Red Cross is moving from paper forms to laptop computers, and some blood banks may have donors privately answer questions using a touch-sensitive computer screen. Errors are reduced, and donors are more likely to give candid answers about their sexual history, says Alan Williams, director of the division of blood applications at the FDA.

Long before the 100th anniversary of the first donor questionnaire in 2053, the forms are likely to become historical artifacts. Scientists are working on ways to sterilize donated blood, eliminating dangerous pathogens. Products made from cow blood are being used in humans overseas, and scientists are working on synthetic blood.

Meanwhile, blood banks are getting ready to ask two more questions. A new drug for prostate enlargement, dutasteride, might cause birth defects if a pregnant woman gets it in a transfusion. And traces of the smallpox vaccine being given to health care workers could cause a severe reaction in vulnerable people.

"We're just about to add those questions here," says Fridey, who works at the City of Hope National Medical Center in Duarte, Calif. "The list isn't getting shorter."

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