By Poyi (Natalie) Leung
Before the Blood Transfusion Centre (BTC) was established in Macau in 1988, collecting blood for patients who needed urgent blood transfusions was certainly not an easy task, as there were a very limited number of donors in the territory.
In the early 1950s, lyophilized plasma and physiological saline or other solutions were the substitutes for fresh plasma when people required blood transfusions as a result of acute bleeding caused by accidents or surgeries.
During the Korean War which was started in June 1950, a trade embargo was introduced and lyophilized plasma was very expensive.
According to Ho Sio Tou, the former head of the laboratory in Kiang Wu Hospital, there were very few blood donors in Macau at that time and blood donation was believed as detrimental to health, the BTC 2008 Newsletter read.
The majority of the blood donors were foreigners such as soldiers from Portugal and Africa, missionaries or civil servants, whilst less than 10 of them were of Chinese ethnic origin.
While some of the blood donors were unpaid volunteers, some were paid by a patient’s family members.
Mr Ho recalled that the Portuguese and African soldiers would sometimes be given a one to three day holiday or rewarded a piece of steak for their meals after giving blood.
The Macao Red Cross also assisted in recruiting blood donors at that time. A hospital blood bank was not set up because of the lack of donors.
Yet, the Conde de São Januário Hospital (CHCSJ) was able to obtain blood through donation by soldiers and foreigners, and its blood stock was even more than Kiang Wu Hospital.
When there were times that patients in Kiang Wu needed urgent blood transfusions, Mr Ho said the Portuguese head of the CHCSJ Laboratory would go to Kiang Wu and bring with him blood units and an interpreter, and he would personally help to transfer blood into the circulatory system of a patient.
The population in Macau increased in the 1960s, and so did the demand for blood transfusions. Blood donors had to be examined by a doctor, undergo a chest X-ray and be tested for malaria parasite and syphilis which were common diseases during that period.
Those who passed the tests could join the Blood Donation Corp, whose members had to give blood and be tested regularly.
While only a small number of the members were unpaid volunteers and some donated blood for their family members or colleagues, the majority of them were paid 50 patacas per 100 ml of blood each time when 400 ml of blood was donated.
Blood donation was allowed once in every three months. The “cash reward” the donors received was sufficient for them to buy a bicycle, a sewing machine or a transistor radio, which were very popular items in Portugal and Africa.
However, after a change in policy Portuguese and African military personnel no longer stationed in Macau, which triggered a dramatic decline in the number of blood donors in the territory.
In order to meet the demand, local hospitals had to purchase blood from a neighbouring city.
In the 1980s when Macau’s economy was improved, the number of paid donors gradually decreased and the neighbouring city also stopped the practice of paying blood donors, and hence the shortage of blood supply returned.
Foreign doctors from Europe then introduced the concept of voluntary non-remunerated blood donation into Macau. The Macao Blood Transfusion Service was set up by Dr. Antonio Luis Isidoro in 1985 and three years later in February the Blood Transfusion Centre was founded with Dr. Isidoro being the first director and also the first blood donor (his blood donor registration number was 0001).
Thanks to the establishment of the BTC along with the policy of unpaid voluntary blood donation, a steady supply of blood was guaranteed in Macau. The number of blood donors had been on a rise since then and the territory has also achieved self sufficiency in its capability to provide blood components.
Adequate blood supply
Twenty one years on, the BTC was moved from Avenida Sidónio Pais to Nape, giving donors and staff members a more spacious, safe and advanced environment to give blood or do laboratory tests.
Dr. Hui Ping, the fourth director of the Macao Blood Transfusion Service who succeeded Dr. Natalia Martins in 1999, and Cheang Seng Ip, the deputy director of the Health Bureau (SS), spoke with the Macau Daily Times recently about the progress of blood donation and transfusions in Macau at the BTC located in Hotline Building.
According to Dr. Hui, the BTC handled altogether 12,420 blood donation in 2008, an average of 238 donation per week.
And as of the end of last year, there were 15,240 registered donors in Macau. Of them, around 5,000 were regular donors, mainly females, who gave blood at least once a year for three consecutive years.
In July this year, Paulo Rodrigues, a Portuguese, successfully gave blood in Macau for the 100th time in his life. He started the donation for a good cause even before the BTC was founded.
Students from secondary schools and universities made up 35 percent of the blood donors. Donors between 20 and 29 years old have been forming the largest age group accounting for around 40 percent annually.
Despite male donors had been leading blood donation in Macau, the situation changed last year and more female donors (50.7 percent) went to give blood.
A person weighing above 50 kg is allowed to give 450 ml of blood each time, or otherwise 350 ml of blood will be drawn (45 to 50 kg).
If a person donates 350 ml of blood, 190 ml of it is in fact water. Dr. Hui said a pack of 350 ml whole blood can be kept for 35 days.
Blood is made up of 55 percent plasma and 45 percent cellular components.
Plasma is largely composed of water (91 percent), and also protein, fat, inorganic salt and glucose. Among cellular components, red blood cells account for 96 percent, followed by white blood cells and one percent of platelets.
After blood is collected from a donor, every unit of it is subject to laboratory tests including blood typing, screening for red cell antibodies, hepatitis B and C viruses, syphilis, as well as Human Immunodeficiency Virus (HIV).
Only when the donated blood passes all tests, it will be separated into four different types of blood components, which are red blood cells (treats anemia, massive blood loss), platelets (helps stop bleeding, generally used for cancer patients), plasma (treats hemophilia, severe liver disease) and cyroprecipitate (treats hemophilia and other diseases with coagulation defects).
However, the BTC director told the MDTimes platelets can no longer be used for transfusions after five days of storage.
Due to the spread of H1N1 Influenza, a question on whether donors had experienced any flu symptoms in the previous two weeks has been added into the health questionnaires to be filled out by donors prior to donation.
Dr. Hui said that in most cases, anemia or low hemoglobin level is the cause that prohibits a donor, mainly females, from giving blood.
It is caused by the dietary habits in society nowadays such as the popularity of fast food, excessive additives in food and the decreasing consumption of red meat, according to Dr. Hui.
Those who fail to meet the required hemoglobin level will be deferred to give blood. They will be given advice to take a proper diet and hopefully they will return again some time later.
Decline in negative blood donors after 1999
In Macau, the most common blood group is O Rh+, standing at 41 percent. It is followed by B Rh+ at 25.6 percent, A Rh+ at 25.2 per cent, and AB Rh+ at 6.5 percent.
In regard to RhD negative blood types, the rarest group is AB Rh- at 0.1 percent, followed by B Rh- at 0.3 percent, A Rh- at 0.6 percent and O Rh- at 0.7 percent.
Dr. Hui told the MDTimes since RhD negative blood types are more commonly found in Caucasians, the stock could be maintained in a steady level in Macau before the 1999 handover.
As Portuguese ethnic residents were gradually leaving the territory, the number of RhD negative blood donors decreased accordingly.
She said only around four in every 1,000 Asian people, especially Chinese but except Indians, have negative blood types. In contrast, more than 10 in every 100 Caucasians can be found to have this kind of rare blood groups.
Therefore since 2005, the Macao Blood Transfusion Service started to seek help from various local organisations such as the Rotary Club, casinos and international schools in order to collect sufficient RhD negative blood to meet the demand.
Dr. Hui said the donation volume has been increasing year on year. At the end of 2008, there were 79 negative blood type donors in Macau.
At the same time, she said the BTC has introduced a new technique to freeze the RhD negative blood cells which is able to drastically extend the shelf life of the blood from 42 days to 10 years.
“With that [the technique] we’re able to have stable stock of RhD negative blood in Macau now,” the BTC director said.
Meanwhile, the Health Bureau deputy director Cheang Seng Ip assured that blood donation gives no adverse impact to the body.
“I cannot say whether giving blood will benefit your health, but for sure it is not detrimental and a healthy body has a mechanism to automatically produce more blood to compensate for the loss,” Mr Cheang told the MDTimes.
While the Grand Prix is just around the corner, Dr. Hui expects that less people will come to donate blood during the race due to the traffic control.
However, she pointed out that apart from local residents, tourists will go to the BTC to give blood especially those from Hong Kong.
“They [Hong Kong visitors] say that we have better [blood donation] equipment and refreshment than Hong Kong and so they like to do it in Macau,” she added.