Do you really understand blood donation and plasma donation?

Blood products play an irreplaceable role in modern medical treatment. They can not only relieve the pain of patients, but also are an important means of saving lives. Recently, the "19-year-old plasma donor in Shanxi died" incident has attracted widespread attention. From a professional point of view, both the media and netizens have some misunderstandings about this matter. We believe that it is necessary to dig deeper into this and have a scientific understanding of blood and plasma donation with everyone.

In my country, blood collection has two purposes: one is to collect blood directly for clinical patient transfusion, and the other is to collect plasma for biopharmaceutical companies to refine into blood products such as human albumin, immunoglobulin and coagulation factors. The former is subject to the "Blood Donation Law of the People's Republic of China", and the latter is subject to the "Blood Products Management Regulations". It can be seen that plasma collection and voluntary blood donation are two completely different things.

What exactly is plasma?

Plasma is an important component of blood, accounting for about 55% of the total blood volume. The main components of blood are blood cells and plasma. Blood cells mainly include red blood cells, white blood cells and platelets. Blood has the functions of transportation, defense, regulating body temperature, regulating body osmotic pressure and acid-base balance.

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Plasma is composed of 90% water, 7% plasma protein and 3% other inorganic salt components, carbohydrates and electrolytes. Its main function is to carry blood cells, transport substances needed to maintain human life activities and metabolites produced in the body.

Plasma is not for sale

Blood donation, as generally known to the public, includes whole blood donation and blood component donation, which is further divided into platelet donation, granulocyte donation or peripheral blood stem cell donation. At present, platelet donation is the most common in my country, which is directly supplied to clinics after being collected by blood stations. According to the Blood Donation Law of the People's Republic of China, my country implements a voluntary blood donation system for clinical use of blood.

Plasma donation refers to the collection of the plasma part of the blood with the help of a plasmapheresis machine, and the return of red blood cells, white blood cells, platelets and other components to the plasma donor. After collection by the plasmapheresis station, it is directly supplied to blood product production units for the production of blood products.

Since plasma donation is not like blood donation, which can be completed in a blood center (blood station), blood donation room or mobile blood collection vehicle, you must go to a fixed plasma station to complete a health check, including health consultation, physical examination, blood test, etc., and donate plasma at the station after all indicators are qualified. The whole process takes at least 1-2 hours, so the plasma station will provide plasma donors with a small amount of subsidies such as "transportation fees" and "lost work wages".

Most people do not understand the difference between donating blood and donating plasma, so when they see compensation for donating plasma, they will have questions like "Is this selling blood?" and "Is this legal?" Being misunderstood and hostile, the public's lack of knowledge of professional knowledge puts plasma stations in an awkward position.

In 2007, the Chinese government website published an article titled "Ministry of Health: Donating blood and collecting plasma are different. Paid plasma donation is not equal to selling blood", which clearly pointed out that voluntary blood donation and plasma collection are two systems. Although the plasma collection stations are backed by enterprises and their natures are very different, their fundamental purpose and role are to provide the public with a guarantee of healthy life as a medical industry.

Is donating plasma harmful to the body?

According to public information, Cao Yang, deputy chief physician of the Department of Hematology at Tongji Hospital affiliated to Huazhong University of Science and Technology, said that what people usually call anemia refers to the lack of red blood cells in the blood. Donating plasma generally does not cause anemia, let alone death.

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According to the national college textbooks "Biochemistry and Molecular Biology" (9th edition), "Hematology" (3rd edition), "Physiology" (9th edition), and "Donate Plasma and Show Love (Sichuan Plasma Donation Reader)" compiled by the Sichuan Provincial Health Supervision Association, donating plasma can promote the excretion of some metabolites in plasma, reduce blood lipids and blood viscosity to a certain extent, and accelerate the excretion of uric acid in the blood, thereby reducing blood uric acid levels to a certain extent.

Plasma and blood products are strictly regulated throughout the entire process

In my country, when blood product production units apply to set up plasma donation stations, they will be preliminarily examined by the health administrative department of the county people's government. After review and approval by the health administrative department of the municipal or autonomous prefecture people's government, they will be submitted to the health administrative department of the provincial people's government for approval. If they meet the requirements after review, the health administrative department of the provincial people's government will issue a "Plasma Donor License" - a system of strict approval at all levels is implemented.

At the same time, plasma donors can only donate plasma at single plasma collection stations with designated plasma collection areas in their registered residences, and cannot donate plasma across plasma collection areas or on a mobile basis. The interval between two plasma donations by the same plasma donor must not be less than 14 days, and the cumulative number of plasma donations within every 12 months must not exceed 24 times, and the amount of plasma donated each time must not exceed 600 grams (including anticoagulants).

Before donating plasma, in accordance with national regulations, plasma donors will undergo strict health checks. In addition to basic indicators such as age, weight, blood pressure, and pulse, there are also blood tests such as blood type, hemoglobin content, serum/plasma total protein content, alanine aminotransferase, hepatitis B virus surface antigen, hepatitis C virus (HCV) antibodies, human immunodeficiency virus (HIV-1 and HIV-2) antibodies, and syphilis antibodies. Regular plasma donors can collect plasma first and then undergo the test.

The Regulations on the Administration of Blood Products stipulate that there are strict penalty standards for single-collection plasma stations that "collect plasma from plasma donors or other personnel outside the designated area, or fail to identify the plasma donors, collect plasma from impostors, those who fail health examinations, or those who do not have a Plasma Donor Certificate", "violate plasma collection technical operating standards and procedures, and collect plasma too frequently and in excessive amounts".

Donating blood and plasma are equally honorable

On December 11, 2011, Chen Zhu, then Minister of Health (Vice Chairman of the 13th National People's Congress Standing Committee, President of the Chinese Red Cross Society), said while donating plasma in Beijing, "my country's blood and blood product supply faces severe challenges. People in good physical condition should actively participate in donating blood and plasma. Donating plasma and blood are both good deeds to save the dying and the wounded, and are a sign of social harmony and civilized progress. I hope more caring people will devote themselves to this noble cause. I hope the whole society will establish the awareness that 'free blood donation is glorious, and paid plasma donation is equally glorious'."

On June 14, 2023, the World Health Organization released the slogan for World Blood Donor Day: "Give blood, give plasma, share life, share often". This is the first time that plasma donation appears in the official theme of World Blood Donor Day, which means that the World Health Organization is encouraging more people to pay attention to plasma and donate plasma.

As an important raw material for blood products, insufficient plasma supply has seriously affected the production of blood products. Nowadays, blood products are important materials related to national medical and health security, playing an important role in the prevention and treatment of major infectious diseases, treatment and emergency rescue of public health emergencies, support of war preparedness materials and military counter-terrorism. Especially during the COVID-19 pandemic, blood products have played a key role in treating severe illnesses and reducing mortality.

As a derivative of plasma, blood products have a longer shelf life and play an important role in the prevention and treatment of certain major diseases and medical emergency that cannot be replaced by other drugs. In my country, there are more than 100 proteins in plasma with clear molecular structures, and more than 20 have been separated and used in clinical practice. The body's immunity, coagulation and anticoagulation, as well as the delivery of hormones, drugs, and nutrients are closely related to plasma proteins. Most blood products cannot be manufactured by recombinant methods at present, but can only be extracted from healthy human plasma.

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With the continuous expansion of medical insurance coverage, the continuous improvement of insurance levels, and the continuous advancement of medical technology, the use of blood products in clinical treatment has continued to grow. As the raw material for the production of blood products, plasma collection is facing new pressures and challenges.

An article on the Chinese government website in 2011 clearly stated that "increasing the amount of plasma collected and improving the utilization rate of plasma are two ways for my country to ease the shortage of blood product supply." Therefore, paying attention to people's livelihood needs, strengthening popular science, standardizing the establishment of plasma collection stations, improving research and development levels, strictly enforcing social management, strengthening supervision and the correct support and guidance of relevant departments are the keys to guiding the healthy development of plasma donation in my country.

Author: Blood Products Branch of China Vaccine Industry Association

Reviewer: Tang Qin, Director and Researcher of the Science Popularization Department of the Chinese Medical Association