I just returned from my blood donation appointment, and I feel guilty. That's not the way it's supposed to work.

When I first starting donating regularly, I was a "whole blood" donor. This means that they stick the needle in your arm, open the spigot, and a pint dumps into the bag. Later in the lab, they usually separate out the plasma, and use the red blood cells and the plasma individually where they're most needed.

Eventually, I asked what was happening with the people who were hooked up to a small machine while they donated. Turns out they were engaged in R1 apheresis. In this process, the blood is pumped out of your arm, and the machine centrifuges it to separate the plasma and red cells right before your eyes. Because about double the volume is taken compared to a whole blood donation, the machine also pumps some saline solution back into your arm to make up for it. The return cycle can feel pretty weird; partly because the saline is at room temperature, which feels nice on the outside, but when you suddenly have a twenty degree difference inside your arm it's a lot different than just being outside on a cool day. Even though more product is taken from you, you can still make an R1 donation just as often as a whole donation (every 56 days).

So I switched to R1, and that became my standard donation. Obviously, I felt better that my decision to donate was helping even more people.

Each time I donated, I wondered what was happening in the back room. People were lying there with tubes in their arms, just as we were, usually covered with heavy blankets and watching a movie or television. And during my 15 minutes giving whole blood, or a half hour spent in R1, I never saw them get up and leave. One day, there was a poster on the wall that said "Platelet donors needed!" I asked what that was about. Turns out, that back room was the plateletpheresis room. Plateletpheresis is like R1, but more so. It takes about two hours; there are eight or more draw/return cycles compared to two in R1 (I think). Not only is saline being returned to you, but some of your own blood components are returned, as well as an anti-coagulant compound (needed because your blood wants to coagulate after having been out of your body, and if it coagulated after being returned to your circulatory system — well, that would be bad). So after the two hours, they have a bag of plasma, and a bag of red cells, just as with R1, but they also have a (much smaller) bag of platelets. Platelets are a component of the blood which cause clotting; burn victims and people undergoing chemotherapy often have a great need for them.

So now I was a platelet donor. This was even better: I was giving most of the benefits of an R1 donation (most because fewer red cells are collected), plus more, and I could do it every four weeks instead of every eight. (Actually, the FDA rules say a platelet donation can be done every three days! But that's only done in real emergencies.)

Until last December. The blood bank used three different brands of plateletpheresis machines, which have different characteristics regarding how fast they draw, how much pressure they use returning, etc. Even though these variables are controllable by the nurse, some machines, like those from Baxter, generally go at higher rates than, e.g., the ones from Haemonetics. I was pretty much always a Haemonetics customer, though once they put me on the Kobe and once on the Baxter. I definitely liked the Haemonetics machines better, even though the process takes longer with them; they like the Baxters better, because they get more product from them. The Tri-Counties Blood Bank (Santa Barbara, California) was slowly becoming a Baxter-only shop. When I started they had two Haemonetics, one Kobe, and one Baxter. About last October, the Kobe disappeared and a Baxter took its place, then later one of the Haemonetics fell. And finally, in December, Baxter was all there was. My donation that day did not go well at all. The return cycle was very painful. The army of nurses around me decided that the situation was not salvageable. We discussed finishing with my other arm, and I agreed to that. Unfortunately, pretty much the same thing happened. They called a halt for the day, having obtained insufficient product for use, yet enough that (after much consultation with the regulation book) I had to wait the two months, because the procedure was aborted with a quantity of red cells that should have been returned to me.

I'm ashamed to say that that put me off donating until March. When I came back, it was for an R1 donation. I felt a bit guilty about "downgrading" my donation. Then eight weeks later (today), I went back for another one and had a problem with the R1 return cycle. I stuck it out until they had obtained a complete donation, then was thankful that the nurse offered to let me skip the last saline return.

And in another eight weeks, I'll be back and will downgrade once again, back to doing whole blood donation. I know it's silly to feel guilty about that. But I do :(