Those who have been used to doing it for some time repeat the gesture regularly and without making any distinctions regarding the potential recipients. But for those who have not yet approached the world of blood donation, knowing that among the beneficiaries there are also children with cancer could be the push that can undo the hesitations. In a historical phase in which the “blood system” is struggling, weakened first by the pandemic and then by the resurgence of respiratory infections that regularly erode the donor quota, the Italian Federation of Pediatric Oncohematology Parents and Healed Associations (Fiagop) wants to help alleviate the difficulties of this period. And not only. Hence the initiativeI love you a lot”, which in view of the World Childhood Cancer Day (February 15) aims to raise awareness among adults to donate blood.
A campaign to donate blood to children with cancer
From 13 to 19 February, it will be possible to join the campaign by donating blood in the transfusion centers of the hospitals where the federated associations operate. Fiagop. Here donors will find the postcards of the “I want you a bag of good” campaign, with which to take a selfie to share on social networks (using the hashtags #UnaSaccadiBene #IostoconFiagop). The appointment represents one of the activities envisaged by the memorandum of understanding signed during the third wave of the Covid-19 pandemic between Fiagop and the Italian Federation of Blood Donor Associations (Fidas), precisely with the aim of recalling the importance that donated blood has for pediatric patients in cancer therapy. That is: approximately 2,400 more each year, divided between children (0-14 years, 1,500) and adolescents (15-18 years, 900). “At least 70 percent of them need to receive multiple blood transfusions during drug therapies,” explains Arcangelo Prete, president of the Italian Association of Pediatric Hematology and Oncology (Aieop). A figure higher than that found among adult patients. And that especially concerns children and adolescents affected by blood cancer (leukemia) and lymphatic system (lymphoma).
Treatments impossible without donated blood
Children with cancer and their families know the importance of always having blood and its derivatives available during oncological therapies. “In some particularly delicate situations, especially when leukemia is diagnosed, a blood transfusion is able to save a patient’s life – continues Prete, who directs the simple departmental structure of pediatric oncohematology of the IRCCS Policlinico Sant’ Ursula of Bologna -. During treatments, on the other hand, it is a support that is currently impossible to do without. This is because the intensity of care in pediatric patients, who are considered better able to tolerate care in the absence of other diseases or risk factors, is higher than that found in adults. This can also be deduced from the fact that children always undergo chemotherapy and radiotherapy in hospitalization and never in day-hospital”. In most cases, the therapies administered to them lead to bone marrow aplasia: that is, the inability of the bone marrow to produce the cells that make up blood. A condition that almost always requires that these be supplied from the outside, through a transfusion. “If there weren’t a broad consensus, it would be difficult to think about treating a child suffering from cancer – explains the expert -. During the course of the therapies, the need for blood for these patients is constant”.
This need is most felt by children affected by leukemia: regardless of its nature (lymphoid or myeloid). Both because the disease directly affects the bone marrow and for the consequences determined by the therapies. Next, those who are struggling with lymphoma (most common disease among adolescents) or a solid tumor. Neoplasms, the latter, which, although not directly affecting the blood, require very intense care due to their aggressiveness. “In the weeks preceding an allogeneic hematopoietic stem cell transplant, every cancer patient receives on average a transfusion of whole blood every three days and one of platelets every 48 hours,” explains Prete. In fact, the need is not only represented by whole blood, but also by some of its components. Such as white blood cells (to deal with any infections), platelets (to prevent bleeding and haemorrhage) and some proteins (from clotting factors to albumin). All donors can help these children. Advanced age is not a discriminating factor.
Fewer blood donors due to Covid-19
Fiagop’s initiative is one of those with which the world of associations is trying to plug the difficulties recorded in the last three years. Although national self-sufficiency does not appear to be at risk for now, blood and plasma collection in Italy is still suffering from the effect of the pandemic. According to data released by the National Blood Center on the occasion of the last World Blood Donor Day (June 14, 2922), in 2021 blood and plasma donors in Italy were just over one million and 650 thousand (-1.8 percent compared to 2019). A slightly higher figure than that of 2020 (1,626,506), but which confirms a downward trend that has now lasted for ten years (-5 percent compared to 2012). The official data for 2022 is not there yet. Considering the diffusion of the Omicron variant which has prevented many regular donors from making this gesture on a regular basis, however, there is no good news on the horizon. “The bill to pay is still high – says Vincenzo De Angelis, director of the National Blood Center -. Even with its less aggressive variants, Covid-19 has had a huge impact on the harvest”. A situation which – in periods such as the current one (due to the spread of infections and other respiratory infections) and during the summer months (the lack of blood is felt particularly in the hottest period of the year) – has determined the postponement of non-urgent surgery. On the other hand, the delivery of life-saving therapies has never been at risk. Just like those intended for children (or adults) with cancer. “All pediatric oncohematology departments are located in tertiary level hospitals, which are always able to provide even the most intensive care – reassures Prete -. Our relationship with the transfusion centers is daily. And if blood is scarce in the structure where children are also assisted, the network between the various transfusion centers is set in motion. We start from those present in the same Region and then also address outside the regional borders, if necessary. This collaboration has so far always guaranteed the availability of blood to our patients, without ever conditioning the therapeutic path of a child”.
How to increase the number of donors?
“The trend of the last few months presents us with numerous challenges – comments Gianpietro Briola, president of the Italian Association of Blood Volunteers (Avis) -. By alternating blood and plasma donation, we could have many more donors who make this gesture at least twice a year: so as to be able to better respond to the country’s health needs”. But the challenge does not involve only donors or potential ones. “If we ask citizens for this manifestation of responsibility, on the other hand it is essential that all the players in the system work to better respond to the needs of those who donate – adds Briola -. I am thinking, for example, of the need to extend opening hours, to a more widespread diffusion of collection centers and to the growing need for healthcare personnel”.
Who can donate blood?
Blood donation is a voluntary and free gesture. How to become a blood donor? First, there is an age limit. You can donate for the first time between the ages of 18 and 60. While the usual donors have an age limit of 65 years: with the possibility of donating up to 70, however, following a further clinical evaluation that certifies good health. Condition, the latter, necessary for all ages to submit to a donation. This explains why having a chronic disease, weighing less than 50 kilograms or sexual behaviors that amplify the risk of contracting infections represents a permanent exclusion criterion. While some conditions – the final days of the menstrual cycle, being recovering from a respiratory infection, from surgery or invasive diagnostic tests, from childbirth, from an abortion, from a voluntary interruption of pregnancy or from a pharmacological treatment based on painkillers and anti-inflammatories – usually determine an exclusion between four and six months. The same applies to those who have had tattoos, piercings or recent trips to tropical areas in the previous months or where there was a high circulation of a specific infectious agent at that time. As for the number of possible donations, it is the National Blood Center that clarifies: “Men can donate whole blood every three months, like women who are no longer of childbearing age. The younger ones, on the other hand, can make a maximum of two donations a year, respecting a minimum interval of three months”. In the case of the donation of individual components, the intervals are different. According to Italian law, plasma can be donated every two weeks. And you can make six platelet donations in a year.
Among the criteria for exclusion from donation, there is also having had a tumor: with only two exceptions, concerning basal cell carcinoma or in situ carcinoma of the uterine cervix. Not even a decades-long recovery – as we are beginning to see today in some adults who have fallen ill with childhood cancer – is sufficient to allow this to be done. A will that, some time after the end of the treatments, is expressed by many former pediatric patients. It is also linked to the desire to give something back to those who are not well at that moment. “This foreclosure – Prete points out – aims to protect both the potential donor, whose physical conditions may not be optimal as a result of the toxicity of the treatments received, as well as those who need blood: at the moment we are not in fact able to exclude the possible presence of dormant cancer stem cells in the blood of those who have been cured even for several decades is absolute”.
We need to find new young donors
In the last decade, the young range of donors (18-45 years) has increased from almost 1.1 million (2012) to just over 866,000 (2021). Even more alarming is that relating to new donors in 2021: down by 24 percent compared to 2011. Yet, an aspect still unknown to most, donating blood is good not only for those who receive it. Beyond the psychological benefit linked to the relapses of the gesture: “Because it involves carrying out some tests that check the state of health, the donation can be considered a moment of preventive medicine for the donor”, declares Giovanni Imberciadori, director of the immunohaematology and transfusion medicine of the Galliera hospital in Genoa. In cases where suspicious values are detected, in fact, it is the same health service that takes charge of further diagnostic investigations. The most significant effects of this potential benefit are found in the cardiovascular and metabolic fields. Several studies have in fact highlighted a reduced risk of developing heart disease among donors compared to the rest of the population. To this we must add that donating blood increases awareness of one’s state of health. This explains why, in general, donors usually follow a wellness-oriented lifestyle. On average, in this population sample, there are higher rates of adherence to the Mediterranean diet, greater attention to physical activity and the (total or partial) renunciation of cigarette smoking and the consumption of alcoholic beverages.
