“Power Red Donations” are another name for describing double red blood cell donations by apheresis. This is a lesser-known form of donating blood but can be a tremendous boost on a community’s blood inventory. Red blood cells only have a shelf life of 42 days in storage, so a constant supply of fresh units is always in demand for replenishment.
Background
Red blood cells (RBCs) are the portion of our blood which transports oxygen throughout the body. When people encounter a loss of blood, a transfusion of packed red blood cells is usually in short order. A single unit of RBCs should raise a person’s hematocrit (Hct) by 3% and it should raise their hemoglobin by 1 g/dL. Depending how low the baseline results are will often determine how many units of blood they will be transfused with. This can be as little as one unit or even a partial unit if its for a neonate. The more red blood cells that are available in a blood bank’s inventory, the better chance that a hospital has in meeting the demands of a patient in need.
Who Is Eligible for Power Red Donations
According to the Red Cross, the following are some specific eligibility criteria for donating Power Red:
Blood Type
O Pos, O Neg, A Neg and B Neg blood types are preferred for Red Cross Power Red donations.
Time Interval
Donation frequency is every 112 days. This is twice the normal 56-day period incurred for a single red donation, due to the increased volume.
Age/Height/Weight
Male Donors must be at least 17 years old, 5’1” tall and weigh at least 130 pounds. Females must be at least 19 years old, 5’3” tall and weigh at least 150 pounds. The difference in standards for this is due to females having a lower average hemoglobin than males. There is a large correlation between hemoglobin and body mass, which is why smaller framed females often miss the hemoglobin cutoff when attempting to donate.
Whole Blood vs. Power Red Donations
Whole Blood
A typical whole blood donation consists of a donor getting screened with a panel of interview questions related to their medical history. They will then get a set of vitals taken. If fully qualified, they will proceed to a phlebotomist chair where they will have a unit of whole blood (about 500 ml) collected through a tubing set, directly into a blood bag. Once the bag is full, the needle is taken out, arm is wrapped and they will be given post-donation care instructions before being dismissed. No type of fluids are infused back into the donor.
Power Red
For a power red donation, the donor follows a nearly identical pre-donation process. The difference begins once they get to phlebotomy. Instead of drawing their blood through a standard blood bag set, they will be hooked up to an automated apheresis machine with a needle. Their whole blood will then be drawn through the tubing into the machine, which will separate the target component (RBCs) from the other blood components and will segregate it into a new container. The non-target components (plasma, platelets & leukocytes) along with saline will then be returned through the tubing into the donor.
Power Red Phlebotomy vs. Whole Blood Phlebotomy
A study performed by a Swiss Red Cross transfusion center provided some useful data based on 291 double red cell apheresis procedures using the ALYX collection system at their facility (Ketevan Keshelashvili, 2016). According to this data, the average phlebotomy time was 25 minutes. An average of 1,035 ml of whole blood volume was drawn, processed and then an average of 432 ml of saline and 126 ml of ACD-A anticoagulant was returned to the donor, leaving an average of 361 ml volume of red blood cells as the final volume retained for blood inventory.
In comparison, the average whole blood phlebotomy is between 5-8 minutes and yields around 250 ml of packed red blood cells once it has been spun down and separated from the plasma.
Whole blood has a quicker draw time, however these time savings are diminished by the fact that it takes whole blood longer to process afterward, essentially equaling out the combined phlebotomy & processing time between the two. Additionally, a whole blood donation results in less red cell product (361 ml vs. 250 ml) at the end of the procedure.
Benefits of Power Red
Donor Health
With a whole blood transfusion, a donor is losing about a pint of whole blood and not receiving anything back. Whereas with a power red, the donor is losing RBCs, but they are at least receiving some of their plasma, platelets and leukocytes back along with some saline. This prevents the donor from losing important clotting factors, nutritional molecules and immune cells.
Efficiency
One of the main benefits of power red is that you are getting twice the boost to the blood inventory with half of the work as whole blood. Instead of going through the registration, interview, vitals, processing, and distribution process twice, it only has to be done once even though twice the RBCs are produced. Power reds are also more efficient because the apheresis machine does all of the processing for the tech while the donor is still in the chair. Whereas with whole blood, after the unit is drawn and the donor leaves, the tech must then spin down the unit and manually express the plasma & platelets into satellite bags. Then they must take more time to weigh and label each component. With power red, none of that extra work is necessary since the machine does it all.
Disease Risk
Since a blood recipient has the potential to receive two power red units from the same donor, this reduces the amount of potential donors’ blood that they must be introduced to during a transfusion. Although to a lesser extent as a platelet apheresis transfusion , this still reduces a recipient’s risk of being infected with many blood-borne pathogens.
Drawbacks of Power Red
Time Commitment
In my experience working in a donor center, fast bleeders could fill up a whole blood bag in about 5 minutes, with average bleeders taking about 10 minutes. However, due to the cyclical draw-return nature of power red apheresis, a donor will have a slightly longer time commitment to the process. This can mean closer to 25 or 30 minutes to complete a donation.
Retention
Recruiting power red donors can prove to be more difficult than whole blood donors due to the additional eligibility requirements that are faced. These constraints can potentially knock out a large portion of would-be donors that are willing to endure the task.
Fatigue
As opposed to plasma and platelet donations, donating red blood cells has the largest impact on a donor’s health, hence the longer recovery periods required in between each visit. Losing red blood cells causes an immediate drop in hematocrit and hemoglobin levels, often resulting in fatigue, lethargy and reduced endurance, especially in athletes and others with high physical demands. By losing twice the normal amount of red cells with power red, this effect can be significantly more noticeable.
Availability
Plasma and whole blood donations are usually more common procedures in the transfusion center world. RBC apheresis, particularly double RBC apheresis is not very common, so finding a center that provides this service can often be hard to find for potential donors.
How Much Do Red Blood Cells Cost?
In comparison to plasma and platelets, red blood cells are in the middle ground as far as blood product cost. This was highlighted in a recent study of amount paid per blood product unit by U.S. hospitals in 2019 (Sanjida J. Mowla, 2021). According to the data, when considering the cost of 1,537 platelets units, the average price of leuko-reduced platelets was $516 per unit and $617 for pathogen-reduced platelets. Average price of Fresh Frozen Plasma was $50 and the average price of leuko-reduced red blood cells was $208.
Conclusion
Donating double red cell apheresis or “Power Red” is a powerful tool in maintaining the nation’s blood supply inventory. Red blood cells are the most requested blood component by medical providers, especially with injuries experiencing massive hemorrhaging. So, for the current outlook, red cell donations of all forms, particularly power reds, will continue to be the nucleus of sustainment for blood component resuscitation programs.
References
Ketevan Keshelashvili, A. O. (2016, September). Adverse events and retention of donors of double red cell units by apheresis. Blood Transfusion, 391-399. doi:https://doi.org/10.2450%2F2016.0237-15
Power Red Donation. (n.d.). Retrieved from American Red Cross: https://www.redcrossblood.org/donate-blood/how-to-donate/types-of-blood-donations/power-red-donation.html#:~:text=A%20Power%20Red%20donation%20allows,blood%20cells%20during%20one%20donation.&text=Give%20more%20red%20blood%20cells,transfused%20and%20needed
Sanjida J. Mowla, M. R. (2021, September). Supplemental findings of the 2019 National Blood Collection and Utilization Survey. Transfusion, 61(S2), S11-S35. doi:https://doi.org/10.1111%2Ftrf.16606
