Bloody business

If you cut your finger during chopping cabbage, you bleed. If you trip over a hole and fall, you bleed. This deep red fluid flowing in our veins occupies a central place in our organism – and thus naturally in healthcare. No wonder it moved the imagination of artists and writers as well, and such legends as the one about Count Dracula took wing.

Blood has the capacity to act as a litmus paper showing you if there are problems in your body. Practitioners in medicine knew this wisdom even before centuries. Analysing blood has been crucial in the past when assessing someone’s health or making a diagnosis. Even before they had any idea about blood groups or the scale of information which might be extracted from one drop of blood.

The practice of bloodletting was central in healthcare until the late 19th century. It was first performed in ancient Egypt and spread to Greece as well as the Roman Empire. Medical professionals back then believed that letting out “bad blood” will stimulate the body to produce fresh and healthy blood as well as it will cause haemorrhages to cease. With the development of medical knowledge, the rather barbaric practice gradually died out. Luckily! Because it did more harm than good.

bloodletting - Blood Donation

At the turn of the 20th century, basic changes started to take place in healthcare. Researchers discovered human blood groups in the early 1900s, and it is one of the most important medical information ever since. In 1907, the first cross matching took place, which means the examination of the incompatibility of the donor’s and the recipient’s blood type. Ten years after it, the first blood depot was created. In the next two decades, the blood transfusion services as well as blood facilities were created and the practice of blood donation institutionalized.

Someone needs blood every two seconds

Nowadays, blood donation is a very widespread practice saving millions of lives. According to the estimations of the WHO, about 108 million units of donated blood are collected worldwide yearly; and about 100 blood centres in 168 countries report collecting a total of 83 million blood donations. Although an increase of 10.7 million blood donations from voluntary unpaid donors has been reported from 2008 to 2013, we cannot sit back and relax about these number, since someone needs blood every two seconds. And more often than not, it is very difficult to find blood donors.

Consider the United States. According to the statistics of the American Red Cross, the number of blood donors in the U.S. are 6.8 million yearly on average. Although an estimated 38 percent of the U.S. population is eligible to donate blood at any given time, less than 10 percent of that eligible population actually do it each year.

Blood Donation Facts_upd

What does the process of blood donation look like?

Blood donation has three types: it can be voluntary, paid or performed with the help of family members. The latter might happen when a patient is in a life threatening condition due to a car crash or any other accident, where it is necessary to act very quickly.

As many of you know, the process looks like the following: the donor goes into a blood donation centre or a healthcare facility. Doctors screen donors for health risks, examine them for signs of illnesses transmissible through blood donation, and determine their blood type. Then blood is obtained typically as whole blood from a vein, and the usual amount of donation is 450 millilitres. The collected blood is usually stored in a blood bank as separate components, and can be stored for a very short period of time. Red blood cells (RBC), the most frequently used component, have a shelf life of 35–42 days at refrigerated temperatures.

I encourage everyone to donate blood. Not only do you receive usually a bar of chocolate or a canned beer as a reward afterwards, but it has health benefits for donors as well, for example it reduces toxic quantities of iron. Not to speak about the fact that a single unit of blood can benefit more patients and save more lives – as it can be separated into various components and give only the necessary blood component to a certain patient.

Blood Donation Process

How can digital health help blood donation?

The digital disruption, which is changing medicine and healthcare profoundly, will not avoid the area of blood donation and blood examination either. Although we are far from having a device like Dr. McCoy’s medical tricorder from the Star Trek series, which could scan a patient, and immediately tell the diagnosis, basic vital signs and health parameters, there are attempts to build it. In 2012, Qualcomm announced the Tricorder XPRIZE competition, where the competitor who comes up with Dr. McCoy’s gadget will receive $6 million.

One of the two finalists, Dynamical Biomarkers Group, delivered a solution in what looks like a cross between a first aid kit and a fishing tackle box. It presented various blood tests in the kit alongside sensors measuring vital signs and a smart scope. It is visible that the contestants are striving for making a simple diagnosing process at the point-of-care (close to the patient wherever her or she may be).

In recent years, liquid biopsy has gained ground in oncology as a new diagnostic method. It is basically a blood test, which is able to detect all types of cancer from a very early stage. I believe that blood samples will play a more pivotal role in determining therapeutic options in the future; and there are already companies who are acting on it. For example, genome sequencing giant, Illumina, has formed a spin-off company called GRAIL to experiment with this blood test, and there are several other companies doing so.

But blood donation is the real challenge. Digital technology should help get more blood donors as well as keep the existing ones motivated, while finding also alternative ways to replace blood because it is usually a scarce resource in any hospital.

Here, I summarized technologies and ways to help change blood donation for the better.

1) Reaching out to potential donors

It is very difficult to recruit blood donors, as it takes time and energy from the part of the donor. There are many communication strategies for effective recruitment. For example, the American Red Cross or many blood donation centres usually recommend their best tips on their websites how to recruit donors and how to communicate the goals and possible results of this fundamentally altruistic action.

And then there are the brilliant communication campaigns. The National Health Service’s Blood and Transplant (NHSBT) in the UK came up with a social media campaign entitled “Missing type” during the country’s National Blood Week in 2015 to raise awareness to the fact that the number of blood donors dropped by 40 per cent in the last decade. They partnered with various well recognizable brands, and started to remove letters from street signs. All the letters such as “A” “B” or “O” signaled blood types. Even the Daily Mirror published a 600 thousand copy print with missing letters, even Radio One picked up the story. The results were incredible! They reached two billion people and 30 thousand new donors registered during the week!

Missing type campaign - blood donation

One year later, the NHSBT came up with another astounding way in communicating to potential donors. With the help of an augmented reality app anyone could see the power of blood donation. The app was connected to an image on an outdoor screen featuring an ill patient and an empty blood bag. Visual recognition was used to detect a sticker on a participant’s arm which then overlays an AR needle. This triggered the blood bag on the screen to fill up and the virtual donor can watch as the image of the sick patient gradually returns to healthy. Thus, the spectator could visualize the result of donating blood, which is a way more powerful tool than talking about it or seeing it written down. Obviously, it resulted in flocks of new blood donors. Very well done, NHSBT!

Augmented reality in blood donation

2) Keeping donors motivated on the long-term

The blood donor return rate is usually much lower than the number of those who decide to donate blood at least once in their lifetime. Brazilian researchers carried out a study about the Ribeirão Preto Blood Center, and found that only 40% of individuals return within one year after the first donation and 53% return within two years. It is estimated that 30% never return to donate. So blood centers and medical facilities have a hard time keeping the first-time enthusiasm alive. Digital technology could help.

The Maldivian Mohamed Shuraih presented an idea in 2017 on a crowdfunding website about the creation of a social media app, which would encourage people to donate blood. The reason behind his idea is the high prevalence of Thalassemia among newborns of the Maldives, which requires regular blood transfusion. With the app, the user would be able to earn badges or rewards from strategic partners as incentives for donating blood. These rewards could potentially range from a month of free Netflix subscription, retail store gift cards, and additional phone credit or airline miles. I bought the idea, please sign me up for at least 3 blood donating occasions for a month of free Netflix!

Incentivizing blood donation

3) Simplifying the process

One of the usual excuses for why not donating blood is usually that it takes a lot of time, and people are too busy for doing it. Digital technology might help shortening the blood donation process.

Not only does it take time, it is carried out with a needle; and sometimes the nurse or the phlebotomist finds the appropriate vein only after long and miserable moments. Such innovations, as blood-drawing robots like Veebot could offer some help. In case of blood tests, the robot reduces the whole process to about a minute, and tests show that they can correctly identify the best vein with approximately 83% accuracy. It is about as good as an experienced human phlebotomist. I can imagine that blood-drawing robots will be lined up for the optimization of blood donation in the future effectively.

As I outlined above, you cannot store blood for a long time, it needs to be delivered to the place of transfusion relatively quickly. This is where medical drones “fly” into the picture. Switzerland is already experimenting with them. In March 2017, the Swiss Post has started to fly drones to deliver laboratory samples between two hospitals in the city of Lugano near the Italian border. In the future, it can become a best practice in safely delivering blood from a blood centre to a hospital.

4) Artificial blood could solve the entire issue of blood donations

Tissue engineering is flourishing with the constant and rapid development of digital technologies. So the idea of artificial blood replacing the need for blood donation altogether is not a far-fetched thought. It might be the direction into the future. In fact, the research how to produce artificial blood basically means the search for finding ways how to produce red blood cells.

In 2015, the NHS announced that the first attempt at giving human volunteers “synthetic blood” made in a laboratory for the first time will take place within the next two years (!). Researchers will make blood from stem cells. They are extracted from either the umbilical cord blood of new-born babies or the blood of adult donors. Eventually, medical professionals hope that the NHS will be able to make unlimited quantities of red blood cells for emergency transfusions. However, the immediate goal is to manufacture specialized donations for patients suffering from blood conditions such as sickle-cell anaemia and thalassemia.

Researchers at the University of Bristol are experimenting with another method. Instead of using stem cells to develop blood cells, they have created immortalized erythroid cell lines that can create the blood cells itself. Once the cell lines are created, using adult stem cells, they can be used to produce red blood cells indefinitely. Dr Jan Frayne, from the University of Bristol’s School of Biochemistry, says that “globally, there is a need for an alternative red cell product. Cultured red blood cells have advantages over donor blood, such as reduced risk of infectious disease transmission”. I hope that within a few years, artificial blood can give us a solution for the scarcity in donated blood as well as the associated health risks.

Blood organizations and Red Crosses worldwide do an amazing job in securing the required amount. These technologies will facilitate their job and if (hopefully) such technologies would ever take their job, they will still use their expertise and experience in new roles. For example, as securing synthetic blood supplies.

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