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Blood is Life

A Friday Story
By Professor Shlomo Mor-Yosef
Director General, Hadassah Medical Organization

Last week we dedicated the expanded and refurbished home of the blood bank at Hadassah-Ein Kerem. Looking around at the more than 100 people gathered to celebrate the occasion, I reflected on how many departments were represented at the ceremony, how little is actually known about the extent of the blood bank's responsibilities – and especially how crucial it is to the functioning of our hospitals and the lives of our patients.

"A hospital is built to repair, improve and save lives," said Dr. Orly Zelig, Head of Hadassah's Grand Rabbin Meyer Jais and Daniele Jais Blood Bank, named by Madame Raymonde Jais in honor of her husband and daughter. "Like the heart, which pumps blood through our bodies, the blood bank functions around the clock – in normal times and during emergencies," Dr. Zelig said. "Blood is life. It can save people or kill them. Without blood, there is no life."

"Every mistake could cost a life," noted Prof. Dina Ben Yehuda, Head of the Division of Hematology, which relies heavily on the blood bank as do the departments of surgery and bone marrow transplantation and the shock trauma unit.

I would like to take you behind the scenes and describe the intense effort involved in ensuring that mistakes don't occur.

"Before the blood is transfused, we have to make sure that everything that happens is correct," says Sigalit Mudahi, PhD, Quality Assurance Manager for all the laboratories in the Medical Center. "This involves many pre-analytical, analytical and post-analytical steps such as checking to see that the blood is indeed the patient's, that it was drawn properly and that the donors complied with the instructions they received – such as fasting – before they actually rolled up their sleeves and extended their arms.

Prof. Yoel Donchin, Head of Hadassah's Patient Safety Unit, elaborated. "We have been working on blood safety measures for the last 15 years, constantly checking and improving them. Our safety measures are well-guaranteed. If errors occur, they occur before the blood arrives at the bank – when the test tubes are labeled and the wrong test tube for the patient could accidentally be sent."

To ensure maximum diligence, he and his colleagues designed special labels for blood units and created a checklist for everyone to follow before the blood is dispatched. Education and training accompanied their efforts – and they established additional checklists for the blood bank itself.

"Quality assurance involves internal assessments and annual audits to examine all aspects of how the blood is handled," noted Dr. Mudahi (pictured in photo on right). "These reviews help improve the system. We have an outstanding staff and we encourage them to report near-miss events, as we are constantly assessing how good we are at what we do."

Dr. Zelig (pictured in photo on right) concurred. "Each of the 40 people in the blood bank has a huge responsibility," she said. "Every day, but especially during crises, they have to be extremely attentive. Unusual circumstances can lead to danger. Our staff understands this and takes their tasks seriously. At the same time, they are people who know how to take the initiative when necessary."

Each year, Hadassah transfuses about 20,000 units of blood and about 50,000 other blood components like platelets and plasma, Dr. Zelig says. The blood bank supplies 20 percent of the red blood cell concentrates, platelet concentrates and frozen plasmas necessary. In addition, HMO collects about 4,000 units of whole blood and 1,600 units of Single Donor Platelets.

"Magen David Adom (MDA) collects most of the blood in Israel, about 95 percent, and we work closely with them, but we supply the blood for our patients when we can. Our blood bank is a mini-collection facility, the only blood collection site in Israel other than MDA. Having an on-site blood bank saves crucial transit time when there is an emergency need for blood products, as in cases of sudden bleeding. We need to have 250 units of blood readily available at all times."

When the lab receives the blood it is screened for blood-borne infections and then separated into four components – red blood cells, plasma, platelets and cryopercipitate, a blood component that is processed from plasma and contains coagulation factors.

Following the impressive ceremony, we toured the new facilities. As Dr. Yuval Weiss, Director of Hadassah-Ein Kerem said, "Our standards are very high and the working conditions should be the same." I am proud to tell you that now they are, thanks to the help we received from Hadassah-International.

After admiring the attractive and efficient laboratories and the new equipment, we arrived at the Donor Room where three young men were reclining on special chairs while their blood was being drawn. Yeshiva students Daniel, Evyatar and Ori are part of a special group that provides Single Donor Platelets (SDP) for special populations. SDP means that the same donor keeps giving platelets to the same patient. This requires a significant commitment of time and effort on their part. "Each week a different group from their yeshiva comes to Hadassah for this purpose," said Hanna Greenbaum, Head of Hadassah's Blood Donor Service.

Dr. Zelig explained that all the yeshiva students come through Zichron Menachem, The Israeli Association in Support of Children with Cancer and their Families. They have committed themselves to supplying blood for the Department of Pediatric Hematology and Oncology – and provide all the SDP its patients need. They help at other times as well, she said, especially before holidays and during the summer when blood donations are down.

Hadassah employees from the Information Systems Department are also regular donors. They understand the need and are all too willing to help throughout the year and make themselves available for emergencies.

During our tour, I was often reminded of the many demands on the blood bank. Recently, Dr. Zelig said, they received an urgent request for blood that a patient desperately needed. It was the middle of the night, she said, not just any night – a weekend night – and not just ordinary blood, rare blood. Rare blood is primarily kept at MDA. People with rare blood types often freeze their own blood and store it for an emergency – but this was not the case.

As usual, the blood bank rose to the occasion. Quickly scanning the donor list, they found an appropriate match and immediately arranged to bring the donor from home to Hadassah. "These crises happen four or five times a year," Dr. Mudahi said with a small smile, "usually consecutively."

Most people don't realize that blood is a medication. Like all medications, it often makes the difference between life and death. At the same time, there's always a risk involved when blood is transfused and the fear of unexpected side effects.

Around the world – and here at Hadassah – researchers are actively trying to discover or develop substitutes for blood. Along with the risks involved in using human blood, there is a greater concern, one of supply and demand.

As Dr. Zelig's story demonstrates, the supply of blood is totally dependent on donors – and specifically volunteer donors. In times of crisis, war, terror attacks and mass casualty events, our entire Medical Center revolves around the blood bank and the urgent need for blood. Everyone – physicians and surgeons, nurses, laboratory technicians and management -- focuses on the blood bank, checking the supply and seeking donors. I remember taking the microphone and broadcasting an urgent appeal for donors over our loudspeaker system – not just once but several times in the last decade.

****

When we think of Hadassah donors, we usually think of our thousands of friends around the world whose contributions and support have made the Hadassah Medical Organization a world leader in so many fields, preserving people's lives, saving people's lives.

In the context of our Medical Center, blood donors have a special status. They make it possible for us to preserve lives, save lives. They, our blood bank's dedicated staff – and the unending services they supply – are the essential component that so often makes a difference in the lives of our patients.

Shabbat Shalom and Chag Succot Sameach,

Shlomo

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