Delicate trip

[Guest guest]

Delicate trip Testing in Indianapolis ensures safety in Springfield

By DEAN OLSENSTAFF WRITER

Published Monday, July 03, 2006

At the end of each day, three ordinary-looking white cardboard boxes are placed in the back seat of Mattingly's Toyota Camry.

But the boxes are anything but commonplace. The health of the Springfield area's blood supply depends on the fate of those boxes. Inside the insulated containers are test tubes containing blood from about 150 donors - tubes that must make their way each night from Springfield to Indianapolis to complete government-mandated safety testing. Otherwise, the blood can't be used. "I've never had anything that's held me up," said Mattingly, 65, an Indiana resident who works for a courier service. After hundreds of blood runs, he doesn't get nervous about something happening to his precious cargo. It is cooled with ice, and he said his company would arrange for a swift pickup if his car broke down. The retired union ironworker and father of five listens to satellite talk radio during the 31/2-hour, 220-mile drive from Springfield to the Indiana Blood Center in Indianapolis. "I love to drive," he said. The only thing that's slowed him down is a knee-replacement in early May. Other drivers have filled in during his recovery. He resumes his route Wednesday. Mattingly is one of many cogs in a system that's designed to provide more than 40,000 safe units of blood each year to patients in the Springfield area and southwestern Illinois. Springfield's Central Illinois Community Blood Center pays the Indiana Blood Center to do the molecular-level testing required by the federal government to screen out blood that might be tainted with hepatitis, AIDS or other infections. Blood is regulated as a "biologic" - something that comes out of the human body and is "transplanted" into another person, like a kidney - and it also is regulated as a drug, similar to insulin. The Springfield center collects blood and produces blood that's ready for transfusion. "We manufacture it in a production line, with all these production-type mentalities to make sure every unit of blood that comes off the assembly line is actually 'manufactured' in the exact same way," said pathologist Dr. Bruce Marshall, the Springfield blood center's medical director. Dan Maloney, a 42-year-old certified public accountant from Springfield, gave The State Journal-Register a glimpse into that production line when he donated a pint of blood June 21, 2005. Toward the end of his donation, which took about 15 minutes, the staff member tending him filled five small test tubes with his blood. Maloney headed for the snack table while she took the bag of blood and the attached tubing, which was clamped at the end, to a machine that she used to clamp off several individual tube sections. The sections, each an inch or two long, would be important for testing later at a hospital. Maloney's unit of blood and the test tubes were carried back to the laboratory at the rear of the blood center, along with eight other units of blood and their own test tubes, inside a cooler. Blackburn, the center's lab director, said ice blocks in the container slowly cooled the blood from body temperature to a refrigerator temperature of between 34 and 43 degrees. The lab staff placed Maloney's test tubes in a refrigerator and began processing the nine units of blood. His unit went into a centrifuge that separated the red blood cells from yellow-tinged plasma. A lab technician used an "expresser" that pushed the plasma out of the main bag and into the bag's second compartment. Once the plasma was out, a liquid preservative, housed in the third compartment, was added to the red cells. The preservative provides nutrients that extend the shelf life of red-cell units. The same lab tech put the bag of Maloney's plasma into a "rapid-freeze" cooler that reduced its temperature to 67 degrees below zero in about 40 minutes. From there, the unit of "fresh frozen plasma" went into a freezer that kept it at minus-22 until it was sent to St. 's Hospital. The night after Maloney donated his blood, four of the five test tubes, along with about 600 test tubes from other people who gave blood that day, were boxed up and placed in Mattingly's car. One test tube from each donation remains in Springfield for follow-up tests, if needed. The Indiana Blood Center, a not-for-profit, independent organization that collects blood in Indiana's state capital, maintains a large lab capable of performing the sophisticated tests required by the U.S. Food and Drug Administration. The center also performs tests for blood banks in Dayton, Ohio, Cincinnati and Lexington, Ky. The lab does tests for between 1,000 and 2,000 units of blood each day. The blood from Springfield arrives in Indianapolis about 9 p.m. daily. Results from the tests are sent via the Internet back to Springfield by about 1 p.m. the next day. On the night of June 21, 2005, a State Journal-Register reporter and photographer tagged along as samples of Maloney's blood, along with the rest of Springfield's batch, entered the blood center's labs.

Inside the lab The spotless labs smelled of bleach and vinegar. Workers wore purple and white lab coats, and there wasn't much gabbing. Workers focused their attention on the machines doing the testing, then recorded the results on paper and in computers. Eight tests are conducted in the center's Donor Testing Lab. One test verifies the donor's blood type - A, B or O - and Rh factor. The others include tests to detect syphilis and antibodies the body produces when infected by the AIDS virus and hepatitis B and C. In the other room, the Nucleic Acid Testing lab checks for the actual presence of the AIDS, hepatitis C and West Nile viruses. Each of the tests requires one to five hours to complete. The testing process is automated and computerized. Drops of blood from donors' test tubes are placed in tiny wells in plastic trays. Some of the trays remain static. Some are kept in motion. Some tests involve a bead with a chemical that is placed in each well while the tray is kept inside a machine that maintains a certain temperature. The color change produced by the bead is noted and measured by instruments to determine if an infection is present. The nucleic-acid testing involves a sophisticated machine called a spectrometer that measures differences in light caused by a luminescent substance that's added to the donors' blood samples. The Indiana Blood Center treats its testing procedures like a science, according to Rhamy, the center's vice president for laboratory services. "We want to do each test the same way each and every time, according to very prescribed procedures, because we want to make sure that it is held to an exactness that's required for this type of testing," she said. "We are so concerned about the sensitivity and precision of what we're doing." For the nucleic tests to detect human immunodeficiency virus, West Nile and hepatitis C, blood from 16 different donors' test tubes is combined for efficiency, Rhamy said. But if the test comes up positive for any of those viruses, lab workers go back and check each sample individually. "There are lots of checks and balances," Rhamy said. "We're very careful with what we do. By the time we're done, the blood is very, very safe." After results of tests on Maloney's blood and other donors' samples were transmitted back to Springfield, workers from the local blood center's donor services and laboratory divisions reviewed the results and labeled the bags of red cells. His blood then was put through a filter that removed most of the white cells, a process called leukoreduction. Doctors order these types of red cells for certain patients to reduce the risk of side effects from transfusions, Marshall said. The blood center filters about 60 percent of the local blood supply in this way in response to the preferences of area doctors and hospitals, Blackburn said. On June 24, 2005, Maloney's red-cell unit was driven to Memorial Medical Center, then sent back two days later for irradiation - an additional step that should kill all white blood cells by exposing the unit to a gamma radiation source, Blackburn said.

Ready for transfusion Dr. Prabodh Shah, an oncologist at Southern Illinois University School of Medicine, ordered irradiated blood for his patient, Mader, 48, of rural Effingham, who had been diagnosed with acute myeloid leukemia. Mader, whose cancer has gone into remission, received irradiated blood and platelets to reduce the chance that his body would reject a bone-marrow transplant if his cancer returned and he needed a transplant in the future, Shah said. Mader received Maloney's blood June 26 while a patient at Memorial. First, a medical technologist in the hospital's lab used segments of the blood-filled tube sections that accompanied the unit to double-check the unit's blood type. Workers also got a blood sample from Mader to double-check his blood type. They mixed his and Maloney's samples to make sure the mixture didn't clump. The presence of clumps, even with matching blood types, would have indicated the likelihood of a potentially deadly reaction. That would have meant the transfusion could not take place, according to s, administrative director of Memorial's laboratory medicine and pathology department. Once those tests were complete, Memorial lab workers put a "Bloodloc" on a plastic bag that contained Maloney's bag of red cells. The Bloodloc is a patented plastic device that resembles a combination lock and is used only once before being thrown out. It was installed on the unit using a unique code - "AMD." Nurses at Mader's bedside had to open the bag by dialing the code, which they retrieved from a bracelet on his wrist. During the next 21/2 to three hours, Mader lay on his hospital bed while the blood dripped into his blood system through a needle inserted in his right wrist.

Dean Olsen can be reached at 788-1554 or dean.olsen@....

How to give blood

Central Illinois Community Blood Center, 1134 S. Seventh St., Springfield.

Hours: 9 a.m. to 6 p.m. Monday; 7 a.m. to 6 p.m. Tuesday through Thursday; 8 a.m. to 4 p.m. Friday. Donors can make appointments, but the center also accepts walk-in donors.

Phone numbers: 753-1530 or toll-free at (866) 448-3253.

Web site: www.cicbc.org

Age requirement to donate: 17 and older. Sixteen-year-olds can donate with written parental consent.

Minimum weight: 110 pounds

Reader Comments

anonymous wrote at 7/3/2006 9:10:21 AM

That certainly was an interesting piece.

http://www.sj-r.com/sections/news/stories/89970.asp