Roll Up a Sleeve to Give a Gift
Conquest - Summer 2008
By Julie Penne
The legendary Blue Wall is alive — and pumping. For Sgt. Jeff Headley, a veteran of the Houston Police Department diagnosed with chronic myelogenous leukemia in 2005, backup from hundreds of his brothers and sisters in law enforcement has come in the form of donated platelets and whole blood units rather than assistance at a crime scene or on a call.
While he’s used to getting and giving that kind of selfless support on the streets of Houston, Headley knows that for now he, along with hundreds of fellow patients, need their help with blood and platelet donations to keep a steady supply in the M. D. Anderson Blood Bank.
Shelly Grogin Schultz, who oversees the Neighbors in Need program, visits with patients and families every day about the tremendous need for blood products at M. D. Anderson and helps identify their champions who could sponsor a community blood drive.
The 34-year-old husband and father of four has relied on blood and platelet transfusions from the day after his bone marrow transplant in April 2008. Since then, Headley has returned almost weekly for blood and platelet infusions to keep his blood counts steady and his recovery on track. Were he on the giving side rather than the receiving end of this scenario, there is no doubt that he would be organizing the police department’s next blood drives.
“Donating blood should be viewed as a community responsibility, like inoculating children, paying taxes, observing the rules of the road. Someday, it may be your loved one who needs a transfusion. Think now about paying it forward.”
— Kathleen Sazama, M.D., J.D., professor in the Department of Laboratory Medicine and president of the Society for the Advancement of Blood Management
“Leukemia is a humbling and pride-plucking experience, but the support of the police department and everyone who gave blood and platelets in my name sustains me physically and emotionally,” says the broad-shouldered cop with the easy smile. “My family and I could only hope for such support for every other patient who comes through these doors.”
Need always crucial
Patients like Headley, who have leukemia and have undergone bone marrow transplants, may require up to 400 units of whole blood and platelets during the course of their treatment. New targeted therapies and refined transplants, while often effective as treatment for leukemia, lymphoma, myelodysplastic syndrome, myeloma and anemia, also have tremendously increased the need for blood products.
“M. D. Anderson has a very large leukemia service and, at some point in treatment, every patient with acute leukemia will require blood or platelets to ensure the best outcome,” says Jorge Cortes, M.D., professor in the Department of Leukemia and chair of M. D. Anderson’s Transfusion Committee. “Unlike saline or potassium, we cannot simply manufacture or order more units at will. With blood and platelets, we need human beings to come in and give so our patients can have what they need for a chance to survive. It is crucial to have the supply on hand every day.”
“People who are hesitant about donating blood need to think about all that our patients are going through every day. They need our help and donating blood is a way to help.”
— Jorge Cortes, M.D., professor, Department of Leukemia
Other patients with solid tumors may require between 15 and 60 units of blood for complex operations that involve multiple surgical teams. Still other patients receiving chemotherapy as treatment for a range of cancers may become anemic and require transfusions to rebound their blood counts and allow them to finish their full course at the optimal dosage.
It is this innovative medical and supportive care and surgical expertise that makes the institution an international magnet for cancer care, and it also makes M. D. Anderson the nation’s — if not the world’s — largest transfusion hospital.
Drug coverage affects blood needs
The last calendar year, M. D. Anderson transfused more than 160,000 units of blood. This year, that number may reach 170,000 and continue to go up. Blood Bank officials estimate the number of transfusions in the coming years could hit the 200,000 unit mark, especially when the expansion of the Albert B. and Margaret M. Alkek Hospital nears completion in 2011 with nearly 200 beds added, to be followed by another 200 new beds in 2013.
In his 35 years at M. D. Anderson, Benjamin Lichtiger, M.D., Ph.D., medical director of the Blood Bank, has seen the need for blood steadily increase, and he is confident that the need will continue to grow in the coming years.
In addition to increasing internal needs, external forces come into play as well. Last year, the Centers for Medicare and Medicaid Services ruled that it will not cover epoetin-alfa injection drugs to fight chemotherapy-induced anemia, except in very specific instances. Commonly known as Procrit and Epogen, these drugs have been administered to patients who needed assistance to build red blood cells. With the decision, patients are now given more blood transfusions rather than being saddled with a hefty bill at the pharmacy.
“Transfusion medicine should be regarded as the fourth element of cancer treatment, alongside surgery, chemotherapy and radiation oncology,” says Benjamin Lichtiger, M.D., Ph.D., chair of the Department of Laboratory Medicine and medical director of the Blood Bank for the past 35 years. “Blood and platelets are vital to making these therapies effective for patients, and we must think of this supply like we do electricity: Every time we walk into the room and flip on the switch, the power is there. We’re continually thinking about how to ensure a proper and safe supply of blood and platelets for our patients.”
Shopping for blood a challenge
But while the demand for blood is massive and constant, the supply often can be short and sporadic.
Six months into 2008, M. D. Anderson’s Blood Bank has collected on site about 35,000 units — a little more than 20% of the total number of units transfused — leaving the center to shop for the remainder of the needed units at some 40 other blood collection centers in Texas and the United States.
“Availability of blood products is our number one issue, and we continually look for new ways to recruit donors,” says Gary Griffin, manager of the M. D. Anderson Blood Bank. “Our goal is to have a three-day supply of blood on our shelves, but it is typically a 1 ½-day to two-day supply. We look for every opportunity to expand our donor base so we can keep our supply steady.”
Griffin adds that the Blood Bank often experiences seasonal ebbs and flows, with donations down in the summer because of vacations. Likewise, there may be an increase in donations in the fall because high schools and colleges are back in session with blood drives, and families resume their routines. This summer, the Blood Bank reported an even greater deficit with floods in the Midwest and an early summer shortage of blood in the Northeast.
Neighbors in Need
Early last summer, due to major blood shortages nationwide, M. D. Anderson was forced to cancel 22 surgeries in a two-week period. It was during the time of this drastic move that an innovative new idea took hold, one that has not only brought in thousands of units of blood but also opened doors to new resources for blood.
Known as the Neighbors in Need program, it consists of trained staff from the Blood Bank who make daily visits to patients in leukemia, lymphoma, bone marrow transplant inpatient units and clinics, as well as to patients who are scheduled for surgeries. In each case, they discuss the importance and urgency of blood products and how each might be able to contribute to keeping a strong supply on hand. While it can sometimes be a tough conversation to have with a patient and family who are facing so many other issues, Shelly Grogin Schultz, who oversees Neighbors in Need, has found that often people simply want to be asked to help.
“Of course, patients are never required to host a blood drive or commit to bringing in a specific number of units, but we talk about who among their support team might be willing to sponsor a blood drive,” Schultz says. “For patients who are from out of town, we contact their local blood collection center, and for our local patients, M. D. Anderson can do the drive. We ask for contact names of someone who will sponsor the drive, whether it be the patient’s church, union, school, employer, civic organization or neighborhood, and then we follow up and do the work to organize the drive.”
As a result of the Neighbors in Need program, more than 700 leukemia and surgical patients have been contacted. From those contacts, 40 drives have been conducted by the M. D. Anderson Blood Bank and 76 drives sponsored by other blood centers beyond the Houston area. Houston-based drives have yielded about 1,000 units and another 1,000 have been brought in from blood centers outside of Houston.
“Since Neighbors in Need started, we have not cancelled any surgeries,” Schultz says. “This is a terrific way for friends and family members to get involved and do something for their loved ones. Patients always hear people ask what they can do for them and giving blood is one of those heroic deeds. Plus, so many patients benefit.”
Taking care of inventory
In addition to finding creative ways to recruit donors, M. D. Anderson also continually looks for new ways to safeguard and maximize the precious supply.
As a result of a number of quality initiatives, the Blood Bank discards only one-tenth of one pecent of blood units collected. It also provides the freshest blood to patients with each unit sitting on the shelf no more than four to five days while the national maximum allowed is 42 days, Lichtiger says. Platelets often are infused in patients the day after collection.
M. D. Anderson’s Transfusion Subcommittee, a group mandated by the Joint Commission, comprises representatives from the departments of Anesthesiology, Stem Cell Transplantation and Cellular Therapy, Surgical Oncology and Ambulatory Treatment Centers, as well as the divisions of Nursing and Pharmacy, who meet regularly to review guidelines and protocols for transfusion. The guidelines were developed about 12 years ago but are frequently reviewed to take into account new therapies and research.
According to Lichtiger, the guidelines are “quite flexible and liberal,” taking into account a patient’s overall condition.
“While each transfusion must meet pre-set medical criteria so we can justify the use of a unit of blood, we work with each physician to look at the overall health condition of the patient,” Lichtiger says. “The Blood Bank permeates every practice, every service at M. D. Anderson, and we collaborate every day with physicians to do what is right for patients. That is what donors should think about as they give: Each of them directly impacts a patient.”
Conquest - Summer 2008