Life on the Line: The Amazing Journey of Donated Blood

If you’ve ever given blood, perhaps you’ve wondered where your donation went.

Maybe you imagined that plump little bag travelling right to the bedside of a patient in hospital. But the reality is even more amazing.

It’s a journey that takes your donation through complex production lines at the heart of Canada’s blood system.

The transformation and testing that happen at facilities across the country such as this one in Brampton, Ont. empower a single donation to help many recipients quickly and safely.

More than a thousand units of donated blood can arrive here daily. Perhaps your own gift has passed through the hands of the people you’re about to meet.

Drivers such as Martin Roth start hitting the road early with equipment needed for donor centres and events, including everything from boxes of blood bags to refreshments and beds. They also transport the donated blood to Brampton.

“You could describe the drivers as roadies for the blood show,” jokes Martin. “We’re basically setting up, and then we have to hustle again to take it down, just like the roadies would do at a rock concert.”

Hustle is vital to keeping fresh blood donations flowing to patients in need but so is care for the donors. That’s something Martin knows in his heart as a longtime donor approaching his own 50th donation.

This roadie has more lullaby in his step than rock anthem as he packs up an event. He’s mindful of those still donating in the beds, careful not to disturb them.

“It’s a very personal, very private thing you’re doing, giving blood,” he says.

Martin and his colleagues support donors to make that deeply personal gift every day. Then through the evening and into the night, they’re bringing back that precious cargo.

On this day, 1,047 units of blood have arrived, to be transformed by lab assistant Samer Kharseh and his colleagues. Processing begins at 6 a.m. after those on the overnight shift have checked each bag for anomalies and signs of damage — anything to suggest the blood inside could be compromised.

Within 24 hours, every unit will be separated into its components: red blood cells, plasma and platelets. Meeting that deadline requires processing to begin even before the blood is fully screened, with the end products placed in quarantine to await results from the testing lab.

The complex operation was a surprise for Deborah Kamath, a microbiologist and production supervisor who came to Canadian Blood Services from a pharmaceutical company.

“I was in awe when I saw how they actually separated the components and what a lot of work went into it,” says Deborah. “Every bag has to be handled by trained personnel.” 

Samer is one of those trained personnel. He came to Canadian Blood Services after working in labs at hospitals in his native Syria followed by a decade at a blood bank in Saudi Arabia.

“When I process the blood, I feel like this blood is going to people that I know,” says Samer. “That’s why I really want to take care of it.”

The units are placed in a centrifuge to spin for about 20 minutes.

The spinning divides the whole blood into layers: plasma on top, red blood cells at the bottom, and in between them a thin layer called buffy coat with the platelets.

Samer uses an extractor to push the different components into separate receptacles that are attached to the donation bag by tubes. 

Red blood cells hang from poles to filter out white cells before they’re stored in a refrigerator.

Plasma is stored in a freezer at -20C.

Buffy coat units are pooled in sets of four with a unit of plasma and put through another spinning, extraction and filtering process.

The final pooled platelet bag is held at room temperature in a machine which agitates it gently to prevent the platelets from clumping.

The production cycle doesn’t stop for weekends or holidays. 

“Without these people working day in and day out, hospitals wouldn’t get what they need for the patient,” says Deborah. “It’s extremely rewarding to know that your work made a difference between life and death.” 

As he works, Samer thinks about the donors as well as the recipients. 

“I know those generous people came and donated blood just to help.”

As units of blood move along the production line, another team in Brampton is testing their safety. Each donation bag arrives at the facility with four test tubes of blood from the same donor.

Staff here also test blood that is processed in some other locations, such as the Atlantic provinces.

“We could get as many as 8,000 test tubes in a day,” says Sheila Annett, a senior medical laboratory technologist who joined Canadian Blood Services about 20 years ago.

Samples are tested for transfusion transmissible diseases, blood group and compatibility.

Most of this testing is high volume and automated. Technologists first spin batches of tubes in a centrifuge.

Another machine swiftly removes the caps from the tubes. It also deposits them in racks for delivery to the various testing instruments. Before 2019 this work was done by hand.

“It’s pretty amazing when you see it,” says Sheila. “This is something that was talked about 20 years ago and it’s actually come to fruition.”

Technologists slide racks of open tubes into testing instruments which deliver results to computer screens for analysis. Some samples may also require additional manual testing, such as in cases where a recipient requires a blood product with particular characteristics.

Within 12 hours of receipt of the samples, testing staff complete all mandatory tests on every tube.

The results can then be matched to the donations being processed by Deborah, Samer and their colleagues.

Products with favourable test results are moved out of quarantine to new storage areas. Those lifesaving materials can then resume their journey to patients.

Much of the plasma will travel first to specialized manufacturers. It will return to Brampton in the form of plasma protein products, a class of drugs for which demand in Canada is exploding.

Other blood products flow more directly to patients in need. 

The orders pour in to lab assistants such as Angela Hunt. She and her colleagues assemble and dispatch the rush requests along with the routine ones that keep hospital blood supplies at adequate levels. 

She’s filled back-to-back rush orders after a highway crash, where the hospital called for updates as the delivery made its way through traffic. On another day, a call at shift’s end was for blood products to facilitate multiple organ transplants.

Sometimes she guesses the story behind an order from a news report she sees later. At other times it comes directly from hospital staff making the request.

“You can hear the urgency in their voice. And sometimes they will tell you what’s happening on their end,” says Angela.

On this day Angela has a rush order for platelets that were requested from a specific donor for a patient in need of a careful match. Now it’s up to her to get that product to the hospital.

“Our patients are relying on us,” says Angela. “We improve the lives of sick people and we even save lives.”

To fill some of her most precise orders, Angela will consult with a technical specialist who can scour inventories across Canada and even abroad. And once in a great while she pulls a unit from this freezer. Red blood cells of very rare types can wait here for decades for a matching patient.

Whatever the need, Angela is driven by a deep personal understanding of the importance of the products she’s sending down the belt.

“Even my own family members have been recipients of blood products. I had a sister that was in a car accident, and I have a sister who was sick at a young age, and that’s actually inspired me to work here," she says.

"I come into work and your patient is my patient.” 

Drivers such as Devinder Saini gather the products for the last leg of their journey. They load boxes onto trucks for delivery to hospitals, or sometimes even to airports for transport by plane to other parts of Canada.

Amid the routine deliveries are trips that stand out starkly. Devinder recalls being dispatched in April 2018 with an order for one of the hospitals that received victims of the deadly van attack on Toronto's Yonge Street.

“I tried my best to deliver the blood on time, because I heard on the radio it was a very bad incident,” he says, recalling a smooth trip through traffic and hospital staff who met him with gratitude. 

Most of the people helped by Devinder’s deliveries never make the news. They’re simply regular people to whom he can easily relate.

Two years ago Devinder became a patient himself, after suffering a major heart attack.

He hasn’t needed blood products yet, but the possibility of bypass surgery in his future is a constant reminder of how quickly that could change.

Not that he would need a drop of blood to be grateful for Canadian Blood Services. Doctors told him his heart attack would almost certainly have killed him if it hadn’t happened where it did: at a hospital, while he was on shift making a delivery.

“Life is the reward for me from Canadian Blood Services,” Devinder says.  

A reward for him, and for all who depend on Canada's Lifeline.