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December 15, 2003

White Coat, Red Bag, White Towel

I first gave blood way back in highschool during a school blood drive. It was a fun experience - pretty much a field trip, except we had to bleed but were fed cookies and juice for our efforts. I was quite proud of how quickly I bled, and was glad that I wasn't one of the few that managed to pass out. After that I had good intentions of donating again that didn't come to fruition until many years later. However, once I graduated and settled into my career I finally managed to start donating on a regular basis.

Canadian Blood Services (CBS) mandates an 8-week period between donations. I'd come in for my appointment, and leave with a hole in my arm, a pint less blood, and another appointment in 8 weeks. The only exceptions I had to this were holidays or other personal commitments, which were not uncommon but still the exception rather than the rule. As such, I could donate as many as 7 times in one year, and did so a number of times. Despite my slow start I quickly accumulated donations, and earlier this year achieved my 25th donation and the accompanying pin. I somehow managed to miss the 15th donation free T-shirt, but truth be told, it's helping people and the free cookies that really matter to me.

I have always been kind of proud at how quickly I could fill a bag with blood. On average, I could leak out a pint in seven minutes. On the few occasions that I was slow it would take up to 15 minutes. My personal best was a zippy five minutes. That's some good bleeding! I've also been proud that my donations have generally been complication-free (other than the one time my vein rolled) and that I've never even come close to passing out. I had hoped to keep this sterling record for my entire life, but earlier this year I had my first experience with the physiology of passing out.

Thankfully, I did not actually lose consciousness or even get dizzy, but what happened was quite disconcerting nonetheless. I was near the end of my donation; the bag was full, and the nurse was drawing the sample vials that were tested. Quite suddenly the core of my abdomen felt hot. Not being menopausal, I knew this heat flash was not normal. After deducing that it was going away after a few seconds, I mentioned to the nurse that I suddenly felt hot. Calmly but quickly she called out for some ice and explained that what I was feeling was the first signs of fainting. She stopped drawing samples, took the needle out, wrapped a tensor around my hole and started applying cold towels to my face and forearms.

What happened? Well, I can't recall for sure, but perhaps that was the one day that I had forgotten to ensure I was well hydrated before coming in. Generally I drink lots of water at work, and don't have to worry about proper hydration. As I wasn't working for most of this past year, I perhaps neglected to drink enough. Other possible causes would be not eating anything soon enough before the donation, being too hot or cold, or even just being stressed. Whatever the case, I had the dubious pleasure of being one of those people flat on their back with little white towels draped over them. What pride I had was efficiently wicked away by those little towels.

I believe that this one incident precipitated what was to follow. The past three donations have all had similar results: I end up with white towels draped on me. All but the last one followed the same pattern: I would donate, but would suddenly feel a hot flash again at the end, while the nurse took blood samples. I know my body doesn't really like having the samples taken, as the technique they used at the time meant that I bled a sample, stopped, bled another one, stopped, and so on, for seven separate vials. My body has perhaps become sensitive to this start-stop bleeding coming from one of my arms, and is simply trying to protect me.

This last donation may be a further indication of that hypothesis. Each time previously, I could bleed for a long time and not have any ill effects until the flow was stopped and started again. Recently CBS changed the collection bags they use to include a blood sample bag. Instead of taking your pint and then drawing blood into 7 separate test vials, they now take sample blood first in one of the three bags, and then redirect the flow into the main collection bag for the duration of the donation. I was asking the nurse about the new bags as she was filling the sample bag, and just as she switched me over to the collection bag, it happened again - a hot flash. This was rather disconcerting, as I had barely given anything at all, and my body was already protesting. But again, the flow had stopped briefly and started again, possibly triggering my body's defenses. I told them to stop, and once again had white towels draped on me.

Saying that my body doesn't like start-and-stop bleeding may be correct, but I believe that there is a more serious issue underlying the problem. Before each donation the donor's blood pressure and temperature are taken. A number of times the nurse has said that my pressure is high, and has even recommended that I see my doctor. Well, each time that happens my doctor finds nothing wrong with my pressure. This leads me to believe that I suffer from a mild case of what might be called White Coat Syndrome: a fear of doctors or medical staff in general. Specifically, I get nervous about having high blood pressure, and thereby get high blood pressure.

The same thing may be happening with my body and hot flashes. Due to that first incident earlier this year, I now fear getting a hot flash again. This, on top of my blood pressure fears, adds yet more stress to my donation appointment, possibly making me more sensitive to blood loss than I normally would be. This is only a theory, but it's all I have to go on at this point.

Well, after this last incident one of the nurses recommended that I take some time off from donating blood. According to her, once this sort of thing starts happening, it can get worse, just as has been happening with me. So, instead of leaving with an appointment 8 weeks from that day, I had to cancel the same appointment I had made coming in and leave with nothing booked. I don't know when I'll try going back again. CBS will call in 6 months to see if I'd like to come back at that point. Maybe 6 months will be enough time, maybe not. If my body is behind these troubles, perhaps it will have forgotten by then. If it's my mind that is causing this, I'm afraid my donating days may be on hiatus for quite a long time.

Perhaps in the meantime, you could find your local blood donor clinic and roll your sleeve up in my place? I'm AB positive, but they need all types. Blood: It's just not in me to give for a while.