Why Do People Avoid Canadian Blood Services?

Friendly reminder that it’s in you to give

Most of us have probably heard or seen an advertisement to donate blood to Canadian Blood Services (CBS), especially when demands are critical; however, given only 1 in 60 Canadians choose to donate blood, why do other Canadians avoid CBS like the plague?

One of the most common concerns when it comes to giving blood are needles and passing out. Those who have trypanophobia tend to shy away from giving blood or even getting tested for their blood type, which is a bit of a harder hurdle to get over. For those that worry about passing out due to the amount of blood they’re giving, CBS has minimum weight requirements in place and snacks around to maintain blood sugar levels to avoid that very situation. If you’re prone to fainting at the sight of blood in general, it’s a bit harder to avoid passing out unless you don’t watch the entire process of blood donation.

Others cite not being aware of where or when blood donations are occurring. It is very easy to find this out information by visiting the CBS website or calling their number at 1-888-2-DONATE. Most donation dates and places are at easily accessible areas and times; there are often convenient blood drives on university campuses and at community hubs. For those that say they haven’t donated blood because they’re never asked or invited to donate somewhere, remember that it’s not only up to CBS to get you to the donation locations.

Some individuals chalk up their lack of blood donations to not having the time or just avoiding it altogether. For those individuals, it’s key to offer incentives such as having rewards for donating a certain number of times or being a first time donor. While CBS does offer pins and certificates for certain levels of donations, it may be worth investing a little money into short campaigns that give out things like $5 gift card. Of course, these types of initiatives appear more like bribery in exchange for blood, when blood donation should be more of an act of altruism.

Medication and chronic illnesses can also be barriers to donating blood. I’m sure there are other individuals like myself that were unaware for years that they could donate blood even while taking medication for a chronic illness. This is why being aware that CBS has a detailed list of medications or medical conditions online that do or do not hinder your ability to donate blood is incredibly important. Otherwise, some eligible donors may avoid donating blood altogether just because they’re not sure they won’t be rejected at the door for taking a particular medication.

Restrictions on how long you have to wait to donate blood after getting piercings and tattoos may also be discouraging younger people to donate. Individuals have to wait three months after getting a tattoo or piercing to donate due to the risks of infection associated with both, which is an important reason to wait to donate blood. However, approximately 36% of Canadians aged 18 to 34 have tattoos based on a 2012 study, younger generations may be showing up less to donate because of blood donation requirements around tattoos. Perhaps if CBS increases awareness about the restrictions, they might catch potential young blood donors before they head to an appointment for their next piercing or tattoo.

Photo: thethunderbird.ca

If you are a man that has sex with men, CBS requires you to wait a year since your last sexual contact with a man to donate blood. The blood ban hits gay men disproportionately since it automatically excludes those who are sexually active or in long term relationships. It also perpetuates the stigma of HIV/AIDs in the gay community, even though you can get HIV/AIDs if you are in a heterosexual relationship. Given that the proportion of individuals that identify as LGBTQIA+ is increasing among younger generations, the CBS should consider changing their donation rules related to men who have sex with men so they don’t lose a lot of eligible donors in the future.

There are many reasons why people avoid donating blood, most of which can be remedied by increasing awareness around restrictions to donating blood, how to get involved, or providing more incentives. CBS should also consider that they may be attracting less of the younger generation due to the rules around donating if you get tattoos, piercings, and men who have sex with men. In the end, I would still urge all of you to look into donating blood and to donate if you can.

HIV Patient in London Cured

Breakthrough leads to the second successful eradication of HIV from a patient

Researchers in London may have cured a man of HIV in the second documented case of prolonged HIV remission. The patient - called “the London patient” for confidentiality - was diagnosed with HIV in 2003, and began retroviral therapy in 2012; shortly thereafter, he was diagnosed with Hodgkin’s lymphoma. Hodgkin’s lymphoma is often resistant to chemotherapy, necessitating a complete bone marrow transplant. The transplant procedure involves radiation therapy to destroy the patient’s cancerous immune cells, followed by the regeneration of the immune system from the bone marrow tissue of a compatible donor. The treatment is toxic, and     often fails to result in complete remission; however, for many, it is the last line of defence against a ruthless disease. Once the transplant was complete and the London  patient had recovered, they  appeared to be HIV free.

HIV infects the immune cells of the host, entering through receptors present on the cell surface. In the early 2000’s, researchers discovered that some individuals were resistant to the disease due to the presence of a mutation in the cell surface receptor CCR5. After further investigation, it was revealed that some strains of the viral subtype HIV-1 exploit the CCR5 receptor for cell entry; the mutation resulted in the production of defective     receptors, preventing the virus from entering the immune cells. Researchers hypothesized that this receptor may someday be useful for the  treatment of HIV.

Fast-forward a decade, and their idea for a treatment has finally come to fruition - albeit not in the way they imagined. In an article published in 2009, a team of researchers reported that they had driven HIV into remission via a bone marrow transplant. The research team were treating a patient with both leukaemia and HIV when they proposed treating both diseases with a bone marrow transplant from a donor with the CCR5 mutation. The recipient, dubbed “the Berlin patient,” underwent complete bone marrow irradiation followed by the mutated bone marrow transplant. It appears as though the CCR5 mutant  immune cells completely replaced the patient’s original cells, thereby conferring resistance to the disease. The patient has remained in both cancerous and HIV remission since treatment.

The treatment has been attempted multiple times since the original publication without success. Researchers in London recently published results indicating they had  successfully eradicated both diseases in a second patient  using a similar method to that which was performed on the Berlin patient. The London patient arrested antiretroviral therapy 16 months post-op and has been in confirmed HIV remission for the past 18 months.

The results of both studies have demonstrated that the elimination of HIV – once thought to be incurable – is indeed possible. The risks of treatment for otherwise healthy individuals, however, almost certainly outweighs the benefits. As mentioned, the irradiation of an HIV patient’s bone marrow is toxic. Successful destruction of all host immune cells is usually tough to achieve, and the risk of secondary infection post-irradiation is high. Additionally, finding a matching bone marrow donor is a difficult endeavour under the best of circumstances; locating a matching donor with a CCR5 mutation is exponentially more troublesome. Unfortunately, the combination of risk and donor match rarity likely relegates this treatment to the realm of experimental medicine, and nothing more. For those patients who are concurrently infected with HIV and a cancer necessitating bone marrow transplantation, this treatment may be an option; however, the availability of donors with a mutated CCR5 gene may inhibit widespread application across HIV and cancer patients. For other HIV  patients, until a viable cure is discovered that involves less risk than bone marrow transplantation, antiretroviral      therapy will likely remain the prescribed course of treatment. Antiretrovirals are effective, inducing nominal side effects in the majority of patients while reducing HIV in the blood to undetectable levels.

Although the London and Berlin patients are not the blinding beacon of hope that some media outlets have described, they are important actors in the conversation    surrounding HIV, and medicine in a broader sense. 

A cure is generally touted as the goal of most disease research. When the cure risks causing symptoms far more severe than the pharmaceutically treated disease, however, our conversation requires a  recalibration. Cures are a  reductionist’s dream, eliminating the need for treatment beyond initial delivery. When the cure exists on the precipice between the experimental and the extreme, however, careful consideration must be used in determining the appropriate trade-off between risk and reward.