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Table of ContentsNews & Events: Around the Hemo Globe 1Blood Love 4Prescription: Rh-Negative 5People: Arm Chair Angels 9Quality Assurance Profile 10ABC: The Blue Platelet Special 12Golden Donors 12Research: Passionate Pursuits 14Virology Lab 14

Stanford Medical School Blood Center on HillviewBy Vince Yalon, Administrator

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Dr. Susan Galel

3373 Hillview Avenue, Palo Alto

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Testing, Testing and More Testing!A message from the Director of Clinical Operations

THOSE OF YOU DONATING at ournew combined whole blood and auto-mated blood collection facility at 780Welch Road might be wondering whathappened to the old donor room at800 Welch. That space is now occupiedby our donor testing laboratory, whichwas expanded to accommodate newtesting equipment. We have imple-mented several new tests in our questto maximize the safety of blood trans-fusion for the patients we serve.

Here are some highlights of the newtests:

Bacterial Screen forPlatelet Products

Blood products may, rarely, containsmall numbers of bacteria. The sourceof these bacteria is primarily donorskin, although bacteria can also be in adonor’s blood stream if the donor hasan infection anywhere in his/her bodyat the time of donation. To minimizethe likelihood that our blood compo-nents will contain bacteria, we questiondonors carefully for evidence of currentinfections, and we clean donors’ skinwith Food and Drug Administration

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AN ARCHITECTURAL GROUP hasbeen selected and the developmentof plans is underway to relocate theBlood Center Administration andLaboratories to 3373 HillviewAvenue in Palo Alto. This building,just outside of the VeteransAdministration Hospital campus,was previously occupied by ReutersNews Service. 3373 Hillview is atwo-story structure accounting forapproximately 50,000 gross squarefeet of space. It is a relatively new(1999) building that has the wide-open architecture that will enable usto add an additional donor roomand construct laboratories designedto optimize blood operations. Wewill also be enhancing our

immunology research labs, prepar-ing the way for new technology andnew directions.

Our expectation is that the movewill take place in the fall of 2005.We will maintain a donor collectionfacility at 780 Welch Road for serv-ice to our Medical Center patientsand families as well as our regulardonors for whom the campus sitemay be more convenient. OurMountain View donor site will con-tinue to serve our more southerlydonors.

We will update you on things as plans continue to develop.Thanks for your commitment to our patients!

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A R O U N D T H E H E M O G L O B E

What’s Going On With Lean?By Jean Stanley, Director of Operations

THE LAST QUARTER OF 2003 was a challengingtime for the Blood Center. We were facing the imple-mentation of bacterial detection for platelet products,the addition of another hepatitis assay, and the needto create a separate product quality control (QC) lab-oratory. Our hospital customerswere also requesting that we beginto provide additional services toassist them in meeting specialpatient needs. It was clear to usthat we needed to plan carefullyfor both current and future growthin order to continue to meet theneeds of the patients, our donors,hospital customers and employees.

As we began to plan the newlayout for the testing laboratory itbecame clear that we needed help.After much discussion and investi-gation we decided to contract witha consultant to train us in LeanManufacturing principles andguide us through implementationof Lean Manufacturing in our lab-oratory operations. What is LeanManufacturing? The primarypremise of Lean Manufacturing is to recognize andremove waste in order to improve operations.

We identified our internal “Lean Team” and beganby videotaping the major work processes in theComponents and Testing laboratories andDistribution areas. Under the tutelage of the consult-ant, we analyzed what we did, identified where wecould reduce or minimize non-value-added steps,began developing standardized work to coincide withour current procedures, and evaluated how we couldcontrol incoming materials to create a continuousflow of work. This included making some operationaland physical changes in each area.

As we worked through the detailed analysis ofemployee time, steps, processes and procedures, wefound that only about 20 percent of what our staffdid was productive work adding value to the end

product. Non-value-added work can be either purewaste or may comprise tasks required due to outsidevariables such as regulations or machine start up pro-cedures. An example of pure waste would be exces-sive walking from point A to point B or idle time

spent watching machine operations.Another Lean tool we used wasidentifying and combining likeprocesses into single work cells,allowing one or two individuals toperform similar tasks instead of sev-eral people performing each taskseparately.

Because we knew that we wouldbe relocating some of our operationsto the new Hillview site in about ayear, we minimized the costs ofremodeling by using the currentfloor plans and fixtures whereverpossible. Of course we realize thatwe haven’t optimized our Leanprocess, so current physical changesin the various areas are consideredpilots. The pilots will allow us to seewhere we have made savings andalso provide us with a better under-

standing of how we can improve what we do whenplanning for the Hillview move. These examples arejust the tip of the iceberg in implementing a success-ful Lean project. There are other Lean tools and tech-niques yet to be tried, but we have already realizedthe benefits of making more space available and free-ing up staff to work on other procedures.

In the Components Laboratory, new work cells andLean processes have eliminated waste allowing us toimplement bacterial detection, identify space for aQC lab, and provide our hospital customers with24/7 coverage in Distribution.

In June, our Lean consultant returned to help uscontinue the Lean implementation in the labs and tohelp us plan for our Hillview move. While the toolsand techniques of Lean have provided us someimmediate successes, we still have much to do before

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(FDA) approved antiseptic solutions.Despite these efforts, it is estimated thatabout 1 in 5,000 blood components con-tains very small numbers of bacteria. Thesebacteria can multiply to high concentra-tions in blood products such as plateletsthat are not refrigerated. Bacteria in plateletproducts can cause serious transfusionreactions or even death of the transfusionrecipient. For this reason, blood centersrecently implemented testing to screenplatelet products for bacteria. There are nodetection methods sensitive enough todetect the small numbers of bacteria thatmay be present in a platelet product on theday of collection. Therefore, we must waitat least one day after collecting the platelet,and then place a sample of the platelet in abacterial culture system. The culture sys-tem continuously assesses the sample forbacteria throughout the remainder of theplatelet shelf-life. This computerized bacte-rial culture system is one of the large newmachines in our testing lab.

Testing of IndividualDonations for West NileVirus (WNV) Nucleic Acid

You may recall that in the summer of 2003we implemented an investigational bloodscreen for the genes (nucleic acid) of WNV.This testing was performed as part of alarge nationwide clinical trial. The testinvolved pooling blood samples from sixdonors and then applying a complex andexquisitely sensitive test for WNV RNA(ribonucleic acid) to the pool. If a pooltested positive, the test was repeated on theindividual samples. Fortunately, the WNVepidemic did not reach our area of thecountry in 2003 and we had no positivereactions on this test. Elsewhere in the U.S.and Canada, this investigational test suc-cessfully detected West Nile infections inblood donors and prevented hundreds ofcases of viral transmission to blood recipi-

ents. However, the 2003 experience alsoindicated that the blood of some individu-als with WNV infection contained suchminute quantities of virus that the pooledtesting method did not reliably detect it.Therefore, this year we added a secondlarge test system to our lab so that wecould test individual donations by thisinvestigational assay. Any donor whoseblood reacts on this test is contacted andasked to consider participating in a follow-up study. A reactive test on a blood dona-tion results in only a temporary (56 day)deferral, as the virus typically clears quick-ly from the bloodstream.

Hepatitis B Virus (HBV)Nucleic Acid Testing

We are beginning another clinical trial of adonor screen for the genes (nucleic acid) ofthe hepatitis B virus. This is in addition tothe routine testing for the hepatitis B sur-face antigen and antibody to hepatitis B.Experience with nucleic acid testing (NAT)for other agents indicates that NAT detectsinfections a little earlier than antigen orantibody assays. Any donors whose bloodreacts on the HBV NAT test but not theother hepatitis B tests would be contactedand asked to consider participating in a fol-low-up study. In this way, we should beable to determine how much sooner theNAT assay detects infection compared tothe currently licensed antigen and antibodyassays.

Of course, all of these safety initiativeswould be meaningless without your gener-ous donations. Many thanks to those ofyou who moved over to the 780 Welchsite. Please let us know if you’d like to takea peek at our new testing facility next timeyou come to Welch Road. If you’d like atour, contact our Processing Supervisor, Jan Webster, at 650-724-3024 or websterj@stanford.edu.

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WE HAVE IMPLEMENTED

SEVERAL NEW TESTS IN OUR

QUEST TO MAXIMIZE THE

SAFETY OF BLOOD TRANSFU-

SION FOR THE PATIENTS

WE SERVE.

Testing, Testing and More Testing!C O N T I N U E D F R O M F R O N T C O V E R

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we can say that we have truly become Lean. A lot has to do with developing a culture wherebyeveryone understands the value of a Lean process. This will not occur overnight and will requireongoing development. Lean is not about reducing the workforce or cutting back on quality. Leanprinciples help us become more productive and efficient, instilling quality at the same time. LeanManufacturing tools and techniques are powerful in assuring we make well-informed and effectivedecisions. Recognizing how to identify and remove waste, control inventories, establish standardwork procedures, and even out our work processes will provide us with the tools we need to meetupcoming challenges and ensure our future.

What’s Going on With Lean?C O N T I N U E D F R O M P A G E 2

Blood LoveBy Elena Griego, Stanford Student with the Community Service Writing Program

LOVE IS IN THE AIR. Just eight short years ago, as the Stanford Blood Center started a tradi-tion of Singles Nights, it also made its debut as a successful matchmaker.

Singles Night began as a way for active donors to give blood while meeting the men orwomen of their dreams. What better way to make blood donation into a social event thanto introduce interested singles to each other at the same time? The Singles Night eventsare held at the Stanford Blood Center three to four times a year, typically around holi-days, when the center needs blood the most. Each Singles Night has a theme—like Luauor Mardi Gras—and features food, social games, art activities, and icebreakers, to enter-tain the love-seeking singles.

It was at one of these Singles Nights that Jonathan Penn, 38, and Karen Handy, 36, fellin love. When Jonathan first heard about the event through a flier advertising to theStanford Blood Center’s regular donors, he thought it was a great idea; a good time to givethe blood he was going to give anyway, not to mention a convenient opportunity to meetother singles. They met at Karen’s first Singles Night event and Jonathan’s second or third.As Jonathan was donating blood he chatted with a friend who casually mentioned thatshe had noticed Karen looking his way that evening. Just as Jonathan began to walk inKaren’s direction, her name was called to donate, so he walked with her and they begantalking and discovered they had several similar interests. The night progressed, and bythe event’s conclusion, Jonathan had Karen’s number in his pocket and a love connectionwas made.

Three years later, on January 30, 1999, Jonathan and Karen were married and todaythey have Singles Night to thank for finding true love. Who would have thought that twopeople would come to the Stanford Blood Center to make a few friends, and instead meetthe person they wanted to spend the rest of their lives with? Jonathan’s advice to othersingles in the area: “Be open to new things, anything can work, and plus, you’ll have acute topic of conversation to share for the rest of your life!”

What began as an idea to make blood donation fun for singles in the Palo Alto areabecame a time for 50 or more very diverse men and women, with the common interest ofdonating blood, to mingle and meet new people. So if you’re single and you feel the urgeto give blood, check out one of Stanford Blood Center’s Singles Nights. Who knows, youtoo might find love sitting in the chair next to you! To find out when the next SinglesNight will take place, visit the Special Events page at http://bloodcenter.stanford.edu.

Jonathan Penn and Karen Handy,shown here at their wedding, met at Stanford Blood Center’sSingles Night.

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By Nicholas Cheng, Stanford Student with the Community Service Writing Program

IN AN EFFORT to provide thesafest possible blood to patients,Stanford Blood Center is leukore-

ducing the majority of its bloodproducts. Leukoreduction, or theremoval of white blood cells from aunit of whole blood, will signifi-cantly reduce the risk of a transfu-

sion reaction in a recipient. Thoughthe technique has been used for some

time on an as-needed basis, this is the first timethat the Blood Center will leukoreduce mostblood products. With the adoption of this pro-cedure, a new need has been created and differ-ent donor base will be required. Because thisnew technology eliminates our ability to pro-duce platelets from units of whole blood,Automated Blood Collection (ABC), also knownas apheresis, has become the sole source ofplatelets for transfusion. Of these ABC dona-tions, there is a great need for blood lacking cer-tain proteins, given the classification Rh-nega-tive.

In order to remove the white blood cells, thewhole blood must be passed through a fine filter.Because platelets are very sticky, they cling to thefilter along with the white cells. With leukore-duction removing the majority of platelets, theresulting blood product can no longer be usedfor production of platelet products, and a newplatelet supply must be solicited.

Because bone marrow produces platelets,patients with incapacitated bone marrow oftendesperately need platelets. Leukemia patients,for example, require supplemental platelets asmuch of their marrow is destroyed duringchemotherapy. Platelets will also be used to aidany person needing a bone marrow transplant orhaving major surgery resulting in a loss of alarge quantity of blood. If a ready supply ofplatelets is not available, a patient’s plateletcount could fall below critical levels, resulting inprolonged or even spontaneous bleeding. Theavailability of platelets is therefore crucial topatient survival.

Not only is a ready supply of platelets neces-sary, but in most instances, specific types ofplatelets are required to prevent serious compli-

cations. Blood containing proteins, as designatedby the Rhesus Factor (Rh-positive), can lead toadverse transfusion reactions. People who areRh-negative and lack these proteins developantibodies upon their first exposure to the pro-teins in Rh-positive blood. The first exposurepresents little or no health risks. However, onceantibodies have formed, subsequent exposureswill result in the recipient’s immune systemidentifying the blood product as foreign anddestroying it.

It is especially important that a woman whois Rh-negative not be exposed to Rh-positiveblood from the time of her own birth to the endof her childbearing years. If an Rh-negativewoman is exposed to an Rh-positive blood prod-uct, she will develop antibodies to Rh-positiveblood. Therefore, if she becomes pregnant withan Rh-positive baby, her immune system willreject the baby’s blood as foreign and attempt todestroy it. Although doctors can treat mild reac-tions, a severe reaction can result in a miscar-riage or even necessitate a very painful intrauter-ine transfusion to replace to baby’s Rh-positiveblood with Rh-negative. In light of the severityof the consequences, it is imperative that theBlood Center have a ready supply of Rh-negativeblood products.

With the inability to make platelets fromleukoreduced whole blood, Rh-negative plateletsfrom ABC donations are needed. ABC allows theBlood Center to collect platelets alone or inaddition to other needed components. ABCreturns unused portions of the blood to thedonor, allowing donors to give platelets everytwo weeks, in contrast to the eight week perioddonors must wait between whole blood dona-tions.

If you currently donate whole blood, pleaseconsider taking the next step in supporting theplatelet supply by becoming an ABC donor.Schedule an ABC appointment next time youdonate—by preventing serious transfusion reac-tions, it is an easy way for you to save a life.

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Halloween S i n g l e s N i g h t

Wednesday, October 27 4:30 p.m.–7:30 p.m.

Hang with the coolest vampires this side ofTransylvania - donate at our Halloween SinglesNight monster bash! Spooky fun, not to be missed!

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The Advancement of Blood Center TestingBy Pamela Donohoo, Stanford Student with the Community Service Writing Program

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STANFORD MEDICAL SCHOOL BLOOD CENTER’Sprimary mission is to collect and distribute enoughsafe blood and blood derivatives to supply the hospi-tals and patients it serves. Patients expect that bloodis safe when they receive a blood transfusion. TheFood and Drug Administration (FDA) is a regulatorybody that makes sure that all precautions are takenwith blood so patients do not get an infection fromtransfused blood.

The first human blood transfusion took place in1818 by James Blundell; since then blood transfu-sions have changed immensely. When patients receiveblood transfusions their immune systems are alreadyweak from existing conditions, so pathogens in theblood have the potential to do serious harm.Detecting disease within the blood has evolved withnew tests and technology. Prior to HIV, donor screen-ing using questions about high risk activity playedonly a small part of the screening process.Questioning of donors became more extensive withtime and now testing of blood is becoming moreextensive with the recognition of new diseases andnew scientific developments.

The Stanford Blood Center has been a leader in

blood safety because, unlike any other blood center,prior to the development of HIV testing the StanfordBlood Center was doing screening based on theknowledge about HIV that was accessible to them.While most other blood centers were waiting for theHIV agent to be identified, the Stanford Blood Centerbegan surrogate testing. Surrogate testing uses aknown test as a substitute for a test or an unidentifiedagent. It detects something statistically or medicallyassociated with the disease-causing agent. It wasknown that this disease caused by HIV existed, that itwas transmittable through blood, and that it causedparticular abnormalities in the immune system.However, the HIV agent had not been identified norhad a test for the disease been developed. TheStanford Blood Center led by example by screeningfor immune abnormalities as evidence of HIV infec-tion in the blood; other blood centers were therebyinfluenced to do something proactive against thetransfer of HIV (then referred to as AIDs) throughblood transfusion. The official Enzyme Immuno Assaytest for HIV antibodies became available in 1985.

The common blood test is a reactive test calledenzyme immuno assay testing (EIA). This test detects

Call for Comments!What do you think of Life Link? Is there a spe-cific topic that you’d like to read about? Do youhave a question about blood donation or trans-fusion medicine? This is your chance to getinvolved. Here’s your opportunity to pose aquestion to our Director of Clinical Operationsor Administrator. The Stanford Blood Centerworks with Stanford Community Writing stu-dents each quarter, so go ahead and recommendan idea for their next article. Send your ideas to:

Stanford Blood Center Attention: Newsletter 800 Welch Road Palo Alto, CA 94304or email them to: mhyndman@stanford.edu

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sBlueMondaysWe find that we are short ofdonors on Monday mornings,and we need to start the weekoff with a solid schedule inorder to meet the needs of thepatients we serve. Please con-sider being a Monday morn-ing whole blood donor. Tomake an appointment, youcan visit the donation page ofour Web site, or call 650-723-7831, toll-free 888-723-7831.Thank you for your support!

the body’s response to an infection or antibodies.Nucleic acid testing (NAT) is a new molecular screen-ing test. It uses polymerase chain reaction (PCR) toamplify genes so the genetic material (DNA or RNA)of the virus or bacteria can be detected. A licensedtest is one that has not only been developed but hasalso been case studied and approved by the FDA.There are two licensed nucleic acid tests, one tests forHepatitis C and the other tests for HIV. There are twounlicensed tests under development. The West NileVirus NAT is in blood center use through an inves-tigative new drug (IND) application by the FDA.Hepatitis B is the other test that is being implementedby the Stanford Blood Center under an IND. NATsare an important development because they candetect the presence of disease within an average often days after the disease has been contracted, whileEIA tests detect disease an average of one or twomonths after contraction.

Pathogen inactivation is an alternative to testing thatis being developed. This procedure puts a chemicalinto a donated unit of blood and activates the chemicalwith Ultra Violet light. The chemical then deactivatesthe mechanism that allows the virus or bacteria toreplicate. Without the ability to replicate, the diseasecannot infect a transfusion recipient. This processcould eliminate the need for further disease detectiontests. However, with current methods, the blood sup-ply is so safe that putting additional chemicals into theblood may cause an unnecessary problem.

Bacterial contamination testing is being used inblood centers. This test is an added precaution thatdetects bacterial contamination of platelets. Plateletsare the first to be tested for bacteria because bacteria

grow most easily in them due to the fact that they arekept at room temperature prior to transfusion.Approximately 1 in 5,000 units of platelets has adetectable level of bacteria. However, only 1 in500,000 infusions has the potential of fatal resultsdue to bacterial infection.

Innovations in the testing of blood are unlimitedbecause currently there are pathogens in blood thatare not tested for, and new diseases continue to bediscovered. The Stanford Blood Center is a front run-ner in new blood testing innovations because it isvery involved in research, by supporting otherresearchers and by being involved in the developmentof new tests. The Stanford Blood Center is also origi-nal in added testing for things such asCytomegalovirus; Cytomegalovirus is a type of herpesvirus and it is especially important that the StanfordBlood Center test for it because we serve patientswith weaker immune systems.

Stanford Blood Center donors benefit from newtesting because if they do have a transmittable diseaseit will be detected sooner and with more accuracy(fewer false positives will be reported) throughNucleic Acid Testing. Because the Stanford BloodCenter is so deeply involved in research and theinnovation of blood testing, donors are not only help-ing thousands of patients by providing the blood cen-ter with adequate amounts of blood, but they are alsoindirectly helping to make blood transfusion safer.Blood donors could further help the blood center inaccomplishing their mission by staying healthy andcontinuing to donate.

a moment in history...1908 French surgeon Alexis Carrel devises a way toprevent clotting by sewing the vein of the recipientdirectly to the artery of the donor. This vein-to-vein ordirect method, known as anastomosis, is practicedby a number of physicians, among them J.B. Murphyin Chicago and George Crile in Cleveland. The pro-cedure proves unfeasible for blood transfusions, butpaves the way for successful organ transplantation,for which Carrel receives the Nobel Prize in 1912.

(SOURCE: AMERICAN ASSOCIATION OF BLOODBANKS/WWW.AABB.ORG)

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news&eventsFor the Good of AllBy Elena Griego, Stanford Student with the Community Service Writing Program

LAST YEAR, LONG-TIME BLOOD DONOR Kory Mingus decidedthat he wanted to do something to positively affect both blood dona-tion and the Leukemia & Lymphoma Society’s Team In Training pro-gram. As he thought about a way to connect two of his life passions,he came to the realization that they were both working for the samecause. What could be a better way to help family and friends withleukemia and other blood cancers than to donate the blood thatcould save their lives?

Kory began giving blood 16 years ago and has been an activedonor since the first time he was brought in to donate by a cowork-er. He became involved with Team In Training (TNT) in 1996 when,while watching his sister in a TNT marathon, he was inspired to jointhe cause because of the enthusiasm of all the volunteers. TNT is theworld’s largest endurance sports training program. In exchange fortraining and support, participants raise money toward curesfor leukemia, lymphoma, Hodgkin’s disease and myeloma.Through Kory’s involvement in both of these programs hedecided that he wanted to do something that could link thetwo.

The TNT program began in 1988 as an effort to raise fundsin honor of the founder’s daughter, a leukemia survivor. Thisgroup of athletes has now expanded to include over 30,000participants who gather at the world’s major marathons year-round to raise money to support cancer research and treat-ment. Why is Kory involved with TNT? He explains, “I lovethe idea that we come together as a team to confirm that theanswer to life is to live it, share it, and make it possible for others todo the same by raising money to fund research for a cure forleukemia, lymphoma, or other blood-related cancers.”

Kory’s initial plan was to have his training team come to theStanford Blood Center to donate as a group. This soon blossomedinto the idea of inviting Bay Area Team In Training chapters to bringtheir teams in to local blood centers for a Peninsula-wide BloodDrive. The event, held for two weeks last November, came to includethe Red Cross, Blood Centers of the Pacific, and the Stanford BloodCenter. It was organized and advertised in Team In Training sub-groups as a way for healthy community-minded people to furtherextend their helping hands. Kory thought “it would be a great way tocombine both the desire to strengthen a connection to the causewhile doing something beneficial for people particularly afflictedwith leukemia and anyone else who needs blood.”

One person’s interest in spreading a common good became a wayfor two non-profit organizations to support each other. At theStanford Blood Center, we are hoping to spread the interest in thisprogram and make it an annual event. Come join us next time as wework hand in hand with the Leukemia & Lymphoma Society to savelives!

For more information about TNT, go to www.teamintraining.org.

Another Way To Save A Life…

Contact Stanford Blood Center’sMarrow Donor Coordinator,Derek Leith, and make anappointment to donate bloodand request that it be screenedfor the National Marrow DonorProgram (NMDP) Registry. Call 650-723-5532 or send an e-mail to derek.leith@stan-ford.edu. For more informationabout the Marrow DonorProgram, log on to the StanfordBlood Center Web site, thenclick the red Donate button onthe left side of your screen.This will reveal the Marrowbutton. Click and you’re there.

Merchant Thank YousWe would like to thank the following merchants for theircontinued contributions to our Centers:

ANDRONICO’SLos Altos

BETTER BAGELSMountain View

HOBEE’S CALIFORNIARESTAURANTSPalo Alto

JJ & F MARKETPalo Alto

NOAH’S BAGELSPalo Alto

SIGONA’SPalo Alto

STANFORD FLORAL DESIGNPalo Alto

“TO EASE ANOTHER’S

HEARTACHE IS TO FORGET

ONE’S OWN.”

-ABRAHAM LINCOLN

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peopleA R M C H A I R A N G E L S

Students Who CareBy Nicholas Cheng, Stanford Student with the Community Service Writing Program

FOR A MULTITUDE OF REASONS, students makeup one of the Stanford Blood Center’s most importantdonor bases. Students who make their first donationin high school or college often become regular blooddonors for life. Many students, in their physicalprimes, do not ever feel tired after a donation. Theirproximity to the blood center makes donation con-venient, even accessible by bike. A few energetic stu-dents involved in a group often get crowds of donorsby sponsoring blood and bone marrow drives fortheir choir, dorm, or sports team.

So what is it that motivates these young people dodonate? For student Rafer Willenberg, the answer isquite simple: “I like helping people. It’s easy. And Imight need blood someday.” This community com-mitment seems to be by far the biggest motivation.Many students jump at a fast opportunity to make adifference. Though almost everyone wants to makesome positive impact on the community, many volun-teer opportunities have time commitments that stu-dents simply cannot squeeze into their hectic sched-ule. Blood donation, on the other hand, is fast, con-venient, and has a very significant role in the commu-nity. As I found when I first donated at the StanfordBlood Center, the entire whole blood donationprocess took me just under an hour from the time Iwalked in the door until the time I walked back out.I even managed to squeeze it in between a morningand an afternoon class. In a student survey, conven-

ience is certainly the key, as almost everyone whodonated indicated that they would donate more fre-quently if transportation was provided to the BloodCenter or the Blood Center came to them. For JuniorJim Rodgers, “… one of the biggest factors when itcomes to people donating blood is convenience. It’snot convenient if you have to make an appointmentand go far away, so people won’t tend to do that. Butif it can be brought closer and made more conven-ient, through a blood drive for example, people seemmore willing to do it. At least that’s how it is for me.”

Although many students seem willing to donate,there are still a substantial number that hesitate.When asked why, responses varied immensely. For asignificant number of students, like this student wish-ing to remain anonymous, the reason is simple fear.“When they figure out how to take my blood withoutusing a HUGE NEEDLE, I’ll be all over that.” Severalstudents mentioned fainting at the sight of blood orafter getting blood drawn. However, of the peoplediscouraged by fear of the blood donation process,many indicated that they may be convinced in someway to donate. When asked what might help themovercome their fear, many students indicated thatknowing how much the blood was needed wouldchange their minds. Statistics about patients whoneeded blood and what it was used for would be per-suasive. Another frequently selected technique forovercoming fear was group donation. Donating bloodwith friends during a blood drive was also frequentlyselected as a remedy for fear.

Despite the seemingly endless barrage of blooddrive requests, it seems that some students have beentargeted many times while others have never beenasked. Freshman Rebecca Rojansky has been asked todonate so frequently that she is now selective aboutthe organizations that she donates for. “Sometimes itdepends upon who is going to be using the blood. If,however, the program is run by an organization that Isupport then I will be more likely to donate,” sheremarked. Of students surveyed, including peoplewho declined, everyone viewed blood donation in apositive light and indicated a desire either to donateor at least support their fellow students who did.

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peopleQuality Assurance:K E E P I N G D O N O R S A N DP A T I E N T S S A F EBy Kirsten Jackson, Stanford Student with the CommunityService Writing Program

EVEN PEOPLE WHOREGULARLY DONATEBLOOD to the StanfordBlood Center may rarelysee anyone who works in the Quality Assurance(QA) Department, but everyone who donates bloodbenefits from the work they do. While members ofthe QA Department often work behind the scenes,they have one of the greatest responsibilities at theBlood Center: keeping donors and patients safe.

The Quality Assurance Department keeps theStanford Blood Center in compliance with safety reg-ulations put forth by the Food and DrugAdministration, the American Association of BloodBanks, and the State of California. They do this by

monitoring blood donation, processing, and storageprocedures, by evaluating the work of staff members,and by reviewing blood center records. In the rareinstance there is an error of some kind at the bloodcenter, the Quality Assurance Department ensuresthe appropriate corrective action is taken and helps

develop new procedures so that the errordoes not reoccur in the future. Before anew instrument or blood donation proce-dure is ever used at the Stanford BloodCenter, the Quality Assurance Departmentensures it is tested thoroughly to makesure staff, donors, and those who willeventually get the blood are safe.

The Quality Assurance Departmenthired three specialists in 2003 to furtherhelp them ensure the safety of all thosewho work with and receive products fromthe Stanford Blood Center. The DocumentControl Specialist centralized and organ-ized all documents at the Stanford BloodCenter for quick and easy retrieval whenthey are needed. The Technical ServicesSpecialist conducts audits and reviews allblood center laboratory procedures. TheDonor Services Specialist is responsible forhandling errors and tackling any areas of

the donation process that needs improve-ment. Together, these specialists help theQA Department find and correct any prob-lems at the Stanford Blood Center.

We have an excellent reputation forsafety here at the Stanford Blood Center because ofour superior Quality Assurance Department. The QADepartment makes sure that all blood donation pro-cedures are safe for our donors and that all thepatients we help receive safe units of blood. Nexttime you donate blood, you can feel even moresecure knowing that the staff in the QualityAssurance Department are working around theclock, though behind the scenes, to ensure bothyour safety and the safety of those you help withyour donations of blood.

From left to right: (Back row) AlisonIanculescu, Danielle Johnson and NormaGutto. (Front row) Elaine Sugasawaraand Patti Lendio.

Celebrate the SeasonMonday, November 15 through Saturday, January 8

Be a holiday hero! Donate blood in one of our Centers around the holidays and you’ll receive

a T-shirt, designed by a patient at Lucile Packard Children’s Hospital, as a thank you gift!L

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people

BOB LAUGHEAD IS NO STRANGER to theblood center, whether he’s on the bed himselfdonating, or in the canteen tending to donorswho have just donated. Bob has been donatingblood since 1947, and volunteering at theStanford Blood Center since 1993 after retiringfrom Stanford Linear Accelerator Center (SLAC)in 1992.

When he worked at SLAC, he was a regulardonor at the blood drives there, and spent a lotof time chatting with the canteen volunteer.Rumor has it that Bob said to him, “When Iretire I want your job”—and now the four timesa year we go to SLAC you’ll find Bob in the can-teen! Before the mobile starts he has breakfastwith a friend who still works there, and after hisshift he has lunch with another.

Bob was an engineer at SLAC for almost 30years, starting work there a year after it openedand before the accelerator was built. He lovedwatching it being built and becoming some-thing, he said. Besides being proud of his workat SLAC, Bob is also proud of the “I Quit Club”he started there in 1967, after he quit smokinghimself on August 1, 1967. He also credits him-self with bringing one of his coworkers,MaryBeth Beerbohm, into the blood center vol-unteer corps—she started volunteering a yearafter Bob and still does a regular shift at WelchRoad.

Bob’s other favorite mobiles to volunteer atare Abbott Labs and Cisco, although whereverhe’s volunteering he always gets there early toset up the canteen his way! “That way,” he says,“I can only blame myself if I don’t like it.” Heloves working with the nurses and the drivers,although helping on the bloodmobile, which hethinks needs a more clever design, especially inthe canteen area, is not his favorite. “You have to

be real good friends just to pass each other inthe bus” he says laughing. His sense of humor isone of the things others love about Bob, too. “Ilove working with Bob, he’s always so upbeat,”says nurse Cindy Boone. “But,” she adds, “Hedoes need to work on his jokes!”

Charge nurse Mary Jo Jones has much praisefor Bob. “He is Mr. Personality and Mr.Dependability,” she says. “Bob is the captain ofthe ship in the canteen, and he is wonderfulwith the donors. I am always confident thateverything will be taken care of when he’s work-ing.”

The first time Bob donated blood was in1947, when a call went out where he workedfor people to donate for an employee who hadjust severed his arm in a piece of machinery.From a workforce of 1200, Bob was one of onlythree people who stepped forward and went tothe hospital. There, they did a direct transfusionfrom donor to patient. From then on, he becamea regular donor. In the early days, he oftendonated at the American Legion, where after-wards the Ladies Auxiliary would serve hotcakesand sausages. To date, Bob has donated a totalof 173 times, all whole blood donations.

When he’s not helping SMSBC out, Bob isprobably busy fixing something at home or vol-unteering for the Salvation Army, which he alsodoes four times a month. He also gets to spendsome well deserved relaxation time at his cabinin the mountains in an old mill town calledWestwood.

Thank you Bob for all you do for SMSBC—we are so lucky to have you as a volunteer and adonor!

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Volunteer Spotlight:Mr. Personality Coming to aCanteen Near You!By Tessa Moore, Volunteer Services Manager

QDailyDecemberDrawings

Wednesday,December 1 through Friday,December 31

Every day in

December, at our

Centers and on our

mobiles, we will hold

a drawing for prizes

donated by generous

local merchants!

goldendonor

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abcT H E B L U E P L A T E L E T S P E C I A L

Golden Donors Know Their ABCsBy Mark Liao, Stanford Student with the Community Service Writing Program

IS IT POSSIBLE TO IDENTIFY a Stanford Blood Donor justby looking at him or her? You can if the person is a GoldenDonor. As a token of appreciation from the Stanford BloodCenter, a black T-shirt emblazoned with this proud designa-tion is awarded to those who have donated whole blood orblood components an incredible one hundred times.Considering that donors can only donate whole blood everyeight weeks, such a sustained effort to this landmark wouldconceivably take a very long time. In fact, several years!

However, recent technological developments have allowedblood collection centers across the nation to perform a newertype of donation process called Automated Blood Collection(ABC), also known as apheresis. The process allows certainblood products to be collected while at the same time replen-ishing the donor’s lost fluid with saline, and subsequentlydonors are often able to donate more frequently: every twoweeks for platelet donors. In this issue, we profile two amaz-ing Golden Donors who donate via the ABC process.

Eve Laraway has the distinction of being one of theStanford Blood Center’s youngest Golden Donors. Sheachieved this landmark at the age of only 35. Working tenhours a day from Monday to Friday, it is hard to imagine thatshe can find the time to donate every two weeks, but some-how she manages to fit ABC donations into her schedule.

In high school, Eve made an effort to donate during blooddrives, but wanted to donate more. As luck would have it,she overheard a woman’s conversation about AutomatedBlood Collection and was fascinated by the prospect of beingable to give a little more to her community. Now, she regular-ly donates every two weeks, up to 24 times a year, andquickly achieved the Golden Donor status last year. Evehumorously notes that ABC is “a great way to rack up pointsin Heaven,” but cites that she feels that she has a duty to giveback to her community because her family has a history ofcancer.

Despite her hectic work schedule, she believes that dona-tions of blood products are important enough to set aside anhour or two every two weeks in her schedule to donate.With mom in tow, she spends the hour donating, which isan “instant excuse to lie around” but still makes a difference.She “cannot recommend it enough” because “people need somuch [blood].”

Automated Blood Collection differs from the standardblood donation process in a number of ways. Most notably, ittakes about an hour to make an ABC donation compared to

the ten minutes it takes to donate whole blood. Because ofthis, ABC platelet donors who come to the Stanford BloodCenter have a chance to watch television, or even read abook if they choose to help pass the time. However, theextended time yields significant rewards. Specific bloodproducts that are urgently needed during that time periodcan be taken, yet allow the donor to give more often than thetraditional blood donation. One fact that is of interest tomany prospective ABC donors is that the needle used to col-lect blood via the ABC process is actually smaller than thetype used for donating whole blood, making the processmuch more comfortable for many.

Stanford Blood Center donors come from all walks of life:Patricia Lucas is another amazing Golden Donor. She is alsoa prominent citizen of Santa Clara County! As a SuperiorCourt judge, she has been a long-time donor at the StanfordBlood Center. She started to regularly donate whole blood in1984, but a few years later she learned of Automated BloodCollection and was attracted to how this special contributioncould help many more people because she would be able todonate more often. Subsequently, she donates about once amonth, sometimes every other month, in order to fit herschedule.

Judge Lucas suggests people donate “for people you knowwho needed it” in order to help encourage donors to donateoften and generously. When she donates, she usually makesan appointment at 7:00 a.m. on a weekday morning so shecan be in the office by 9:00 a.m. Although her donationschedule has been made more difficult because of her workschedule, she makes the effort to point out that healthy indi-viduals should donate whenever possible, whether it is at theBlood Center or at an organized blood drive. She encouragesprospective ABC donors to learn how the process benefitspatients, and how easy it is to donate. Judge Lucas loves thefact that technological advancements mean that she onlyneeds to donate with one arm compared to ABC collection ofthe past that required both arms to be used. It is also muchfaster than before.

Whether you choose to donate by Automated BloodCollection or to give whole blood, it is important to keep inmind that each gift helps save lives. Certain periods of time,such as the winter and summer holidays, are particularly tax-ing on the nation’s blood supply, and donors of all types areconstantly needed.

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OVER THE YEARS, Stanford Blood Center hasworked hard to meet the increasing demand forblood. Automated Blood Collection (ABC) tech-nology, also known as apheresis, helps us opti-mize blood donations, making the best use ofyour time and your generous gift to patients.By closely monitoring daily needs and by usingABC, we are able to tailor donors’ blood dona-tions to local patients. When customizing dona-tions, we consider factors like your blood typeand how many times per year you donate.

In the past, a unit of whole blood was separat-ed into its three main components: red bloodcells, platelets and plasma. Surprisingly, it took thecombined efforts of SIX whole blood donors to pro-duce ONLY ONE therapeutic dose of transfusableplatelets. Automated blood donations are most effi-cient since you—as ONE person, in ONE donationevent—can give full transfusable doses of the com-ponents most needed by patients. For instance, wecan collect doses of all three components or multi-ple doses of certain components. Most donors canprovide at least two transfusable patient doses ofplatelets, and some can even provide three doses!

Patients benefit the most from ABC because theyare receiving your life-saving blood. Automateddonations ensure that the blood componentspatients need come from fewer donors—whichdecreases the likelihood of transfusion reactions thatcan occur from multiple donor products. Patients’families and friends benefit, knowing they will shareanother day with their loved ones. The communityalso benefits because by donating multiple productsfor patients, you help reduce healthcare costs.

This year, Stanford Blood Center has introducedABC to whole blood donors at our Stanford Campuslocation. You will be seeing new brochures andposters, and our donor services staff will be newlytrained and updated so you can get immediateanswers to your questions about ABC. Guidance onyour preferred donation process will be tailored toyou, and based on the immediate needs of patients.

There are multiplecombinations of bloodcomponents that maybe donated throughABC. You may beasked to donateplatelets with redcells, red cells andtwo plasma units, ordouble units of redcells. For somedonors, whole bloodwill continue to be the best type of donation.ABC donations are safe, sterile, and take any-where from 25 to 90 minutes, depending onwhich blood components are donated.

If you meet certain eligibility criteria and areinterested in ABC, our staff will collect a “purpletop” tube of blood in order to run what’s called aHemogram. This test will tell us your platelet count.We will then know which donation process is bestsuited for you.

No matter which donation type you make whenyou visit the Stanford Blood Center, you can restassured that you are saving the lives of localpatients.

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a moment in history...1939/1940 The Rh blood group system is discovered by KarlLandsteiner, Alex Wiener, Philip Levine, and R.E. Stetson and is soon recognized as the cause of the majority of transfusion reactions.Identification of the Rh factor takes its place next to the discovery of ABOas one of the most important breakthroughs in the field of blood banking.(SOURCE: AMERICAN ASSOCIATION OF BLOOD BANKS/WWW.AABB.ORG)

Stanford student,Kelsey Lynn,makes an ABCdonation ofplatelets.

ABC Supervisor,Mars Mallari,checks Lynn’sprogress.

Have You Taken Your Blood for a Spin?

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researchP A S S I O N A T E P U R S U I T S

Viral Immunology Laboratory Investigates HCV and HTLV

Stanford Medical School Blood Center has three academic medical directors. They are faculty members ofthe School of Medicine that run research laboratories. Dr. Carl Grumet leads the Histocompatibility labora-tory; Dr. Ed Engleman leads the Cellular Immunology laboratory; and Dr. Steven Foung leads the ViralImmunology laboratory. Each of these research teams strives to develop and improve testing and treatmentfor patients in need. The Blood Center is proud to provide support for their amazing work.

tTHE RESEARCH FOCUS of the Viral ImmunologyLaboratory is on two blood transfusion-transmittedviruses, Hepatitis C Virus (HCV) and Human T-cellLymphotropic Virus, type I and II (HTLV). We want toknow how these viruses infect our bodies at the cellu-lar and molecular level, how our immune system fightsagainst them, and how they can escape from immunecontainment. The approach is to dissect the antibodyimmune response by producing and characterizinghuman monoclonal antibodies (HMAbs) to these virus-es. Information gained from this effort has contributedto improving diagnostics for HTLV and in developingnew therapeutics to prevent or to treat these viralinfections.

In the case of HCV, most acute infections becomechronic after several decades leading to liver failureand hepatocellular carcinoma. Half of the liver trans-plants in the U.S. are performed to treat liver failurecaused by HCV infection. Over 170 million peopleworldwide and over four million Americans are chroni-cally infected with HCV. The economic burden is over-whelming; in the U.S. alone the estimate is well overseveral billion dollars each year. Therapy with com-bined interferon and ribavirin has led to clinicalimprovement for some patients with chronic HCVinfection. But major limitations include significantadverse treatment side effects and a high relapse ratewhen patients discontinue therapy. Short of a vaccine,we are exploring the use of HMAbs to prevent and per-haps to treat HCV infections.

First, we want to determine the structure of thevirus envelope proteins since they are responsible forvirus attachment to the cell surface leading to entryinto susceptible cells. To isolate antibodies that aremore likely to block these early steps of infection, wedeveloped a large panel of HCV HMAbs from HCVseropositive blood donors who are asymptomatic from

the infection. Our logic is that this group of individu-als is more likely to be part of the 20 percent of infect-ed people with an immune response capable of con-tributing to a complete recovery. From selected blooddonors, we generated HCV HMAbs that are broadlyreactive to different virus isolates found in the U.S. Wedetermined that some of these antibodies neutralizethe virus, and we are determining the mechanisms ofhow antibodies mediate virus neutralization.Antibodies can respond at different steps of virus infec-tion. Antibodies can attack the virus not yet attachedto liver cells by directly or indirectly inhibiting theinteraction between cell surface receptors and the virusenvelope proteins. Antibodies can also work againstthe virus after binding to the cell surface. Several bio-logical assays have been developed to test this func-tion. To improve on the therapeutic properties of theseantibodies, we are analyzing and molecular-cloningselected antibody genes, which will lead to improve-ments on virus neutralization potency.

Besides HCV research, the second set of viruses westudy includes HTLV-I and HTLV-II. These are twoclosely related transfusion-transmitted retroviralpathogens of emerging significance. HTLV-I causes alymphoproliferative malignancy, called adult T-cellleukemia/lymphoma (ATLL). The cancer tends todevelop in patients infected shortly after birth and aftera prolonged latency period of 20 to 30 years, suggest-ing that age at the onset of infection is a factor. Thelifetime risk to develop ATLL is estimated at 2 to 5percent of people with HTLV I and II. The diseasecourse can be acute and rapidly progressive with anaverage survival of six months. HTLV-I and -II also areassociated with a progressive neurological disorderthat is gradual in onset. Our investigation is a detailedanalysis of the antibody response to HTLV-I and HTLV-II among infected individuals. To date, we succeeded

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Check out Stanford Blood Center’s research program on our Web site athttp://bloodcenter.stanford.edu - click on the Research tab on the home page.

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From left to right: Paochen Zhang, Lilibeth Lorenzo-Fernando, Dr. Jinming Xia, Judy Rowe, Dr. Zhenyong Keck, Dr. Ta-Kai Li, Hongying Chen and Dr. Steven Foung

in producing a panel of HMAbs to HTLV-I and -IIstructural proteins from peripheral B-cells of HTLV-I &HTLV-II infected individuals. The molecular and bio-chemical characterizations of viral epitopes identifiedby these HMAbs have led to better diagnostic tools forHTLV-I and -II disease association studies.

Dr. Steven Foung is the principal investigator of agroup of scientists with backgrounds in molecular andcell biology. The research team is assembled with PhDscientists, Master level and other research assistants.Dr. Jinming Xia, with expertise in biochemistry,worked in biotech and drug discovery companies inthe Bay Area prior to joining this laboratory. On theweekends, he enjoys hiking with his wife, Mei, and hisdaughter, Nancy. Dr. Ta-Kai Li trained in immunologyand cell biology at Harvard and the National Instituteof Health (NIH) and is responsible for human antibodyproduction and characterization. He enjoys his familylife with his wife and 7-year-old son. Their favoritevacation is a trip to Disneyland. His favorite hobby iswatching old movies. Dr. Zhenyong Keck is the seniorscientist and trained at Caltech and the NIH. She hasworked in the biotech industry on the discovery andcloning of new viruses that cause hepatitis and otherdiseases. She said, “To me, the most attractive andexciting aspect of our research is the discovery of newtherapeutics with the hope of one day making a differ-ence in patients’ lives.” She exercises daily and swims amile a day, and sometimes she tops this off with anhour of cycling. She enjoys spending time with herdaughter but hates chauffeuring her around on theweekends since she is constantly getting lost going

from one activity to another. Honying Chen has hadexperiences in drug discovery by studying protein-pro-tein interactions using molecular biology, cell biologyand pharmacology both in the academic and corporatearea for nineteen years. She and her husband, Qimin,enjoy hiking, watching Chinese movies, and eating outon the weekends. Judy Rowe, born and raised inCalifornia, began work as a clinical laboratory scientistand then switched to research. On her down time, sheenjoys reading and gardening. Her favorite genre ismurder mysteries and she also enjoys spending timewith her family in Santa Rosa. Lilibeth Lorenzo-Fernando has been with the lab for over seventeenyears. She said, “there are many big experiments andprojects running in the lab and many of them startwith my supporting work.” With four children rangingin age from three to 13, she has organized their activi-ties to minimize travel, no more than one to two placeseach weekend. Sunday is the most peaceful time forBeth. After church in the morning, there is a familylunch where she does not have to cook. PaochenZhang is the newest member of the lab and providesadministrative support. She is helping immeasurably tocomputerize the lab’s databases. Paochen has threechildren and “has no life” on the weekends. When sheis not driving her children hither and yonder, she andher husband enjoy camping with their kids. She said,“The lab is very productive and generates lots of data. Iam looking forward to applying my previous Data BaseManagement System experiences to the bio-sciencesfield. It is great to work in the challenging, friendlyenvironment.”

NONPROFIT ORG.US POSTAGE

PAIDPALO ALTO, CAPERMIT NO. 28STANFORD MEDICAL SCHOOL

BLOOD CENTER

Stanford Blood Center800 Welch Road

Palo Alto, CA 94304

stanford blood centerStanford Blood Center(new combined location)780 Welch Road, Suite 100Palo Alto, CA 94304

Stanford Blood Center Donor HoursPalo Alto Center -Monday 9:00 a.m. – 12:30 p.m.*

*Whole Blood only12:30 p.m. – 4:30 p.m.4:30 p.m. – 6:30 p.m.* *ABC/Apheresis only

Tuesday Noon – 7:30 p.m.Wednesday 7:00 a.m. – 2:30 p.m.Thursday Noon – 7:30 p.m.

7:30 a.m. – 10:30 a.m.**ABC only

Friday 7:00 a.m. – 2:30 p.m.Saturday 7:00 a.m. – 2:00 p.m.(Hours are for all donation types,unless otherwise noted)

Stanford Blood Center of Mountain View515 South Drive, Suite 20Mountain View, CA 94040

Mountain View Center – Whole Blood DonationsMonday 9:00 am – 5:30 pmTuesday Noon – 7:30 pmWednesday 9:00 am – 5:30 pmThursday 9:00 am – 5:30 pmFriday 9:00 am – 5:30 pmSaturday 8:00 am – 12:00 pm

Mountain View – ABC/Apheresis DonationsMonday 1:00 pm – 6:30 pmTuesday 7:30 am – 12:30 pmWednesday ClosedThursday 1:00 pm – 6:30 pmFriday 7:30 am – 12:30 pmSaturday 7:30 am – 1:00 pm

A special thanks to the following people who contributed to the newsletter:

SUSAN A. GALEL, MD,Director of Clinical Operations

ZENYONG KECK, PhD, Virology LabMICHELE HYNDMAN,

Public Relations ManagerTESSA MOORE, Volunteer Services ManagerJEAN STANLEY, Director of Operations

PATRICIA STAYNER, RN, Director of Donor Services

JENNIFER RECZKOWSKI,Center Recruitment Consultant

VINCE YALON, AdministratorNICHOLAS CHENG, Stanford Student with

the Community Service Writing Program

PAMELA DONOHOO, Stanford Student with the Community Service Writing Program

ELENA GRIEGO, Stanford Student with the Community Service Writing Program

KIRSTEN JACKSON, Stanford Student with the Community Service Writing Program

MARK LIAO, Stanford Student with the Community Service Writing Program

Blood Donor Carlin Black poses with the T-shirt and license plate frame that he earnedwhile saving lives! Thanks Carlin!

Palo Alto and Mountain View Centers closed Sundays and Holidays.ABC/Apheresis donations are by appointment only.

Please send Life Link questions & comments to:Stanford Blood CenterAttention: Michele Hyndman800 Welch RoadPalo Alto, CA 94304mhyndman@stanford.eduOr call, 650-723-8237

Appointments:650-723-7831 or 888-723-7831Resource Nurse: 650-725-9968Administration: 650-723-7994Fax: 650-725-4470Web Site: http://bloodcenter.stanford.edu