Randal Covin

The Blood Bank of Hawaii is not at the forefront of changes that make it easier for people to donate blood, and that’s by design.

Medical Director Dr. Randal Covin describes the center as "very conservative" in its approach, with the safety of blood donors and the patients who receive their lifesaving gifts of foremost concern. So the new donor eligibility rules that took effect Tuesday are a milestone, coming after a decade of scientific research showing that it’s safe for some people who previously were deferred to roll up their sleeves and contribute. This includes many former cardiac, cancer and respiratory patients, and people with certain tattoos and piercings.

"I think that maybe a lot of people don’t donate because they don’t think that they’re eligible or they may have been deferred in the past because they weren’t eligible, but with some of the revisions that we’ve made, we might find a number of donors who are now able to come back," said Covin, 52, who along with his duties at the blood bank is an assistant clinical professor at the University of Hawaii’s John A. Burns School of Medicine.

He encouraged people to check out www.bbh.org for more information about the new rules and upcoming blood drives, or to stop by either of the blood bank’s two permanent sites, on Dillingham Boulevard and Young Street.

Covin was born and raised in Minnesota, where he earned his undergraduate and medical degrees. Advanced studies and training in internal medicine, pathology and blood banking and transfusion medicine took him to Oregon, Michigan, Colorado and New Jersey before he joined the Blood Bank of Hawaii nearly eight years ago. Now he lives in Waikiki, where he enjoys walking for exercise, and looks forward to annual visits from his parents, who still reside some of the year in Minnesota.

"They love it here. I think this is their favorite of all the places I’ve lived!"

QUESTION: We have read in the news recently about the new rules on eligibility for donors. That should promote more blood donations, right?

ANSWER: Yes, it should. But we should point out the real reasons why we’re making the changes. It’s actually something we’ve been looking at for a while. It’s not because we don’t have enough donors or we’re very low on blood. What we really want to do now is reflect the current medical knowledge and the standard of practice that’s in the blood-banking community in the United States. 

Q: And the blood goes through all sorts of testing before it’s actually used?

A: Oh yes, of course. … Whenever we look at making these changes, we always look at a number of levels. First and foremost are the regulations that come from the FDA (U.S. Food and Drug Administration). We always have to make sure no matter what’s going on, no matter how bad we might need donors or how bad we might need blood, that we always follow the federal regulations. The second level is our professional standards. The main professional group for blood banking is the AABB, formerly known as the American Association of Blood Banks. We always want to make sure that we’re compliant with the standards they publish. The third level is what’s available in the medical literature: What does the blood-banking literature say about who’s safe to donate and who’s not? 

Then the next level down is the standard of practice in the community: What are the other blood centers doing in the United States? Who are they accepting? And if they’ve changed their criteria, how has it gone? Is it making it sure that it’s safe for the donor to donate and for the blood to be distributed to other people? 

And then finally is the local level. We also have to decide if this is the right thing to do in our community. So we have gone through all of those levels and are very comfortable that there shouldn’t be any effect on the safety of the blood supply or on the safety of the donors. We actually had to submit our new criteria to the FDA and they pre-approved it before we were allowed to put it in place. …

Q: So taking into account all those factors, I’m assuming that you folks … are not the first to do this. Are there other blood banks in the United States that have already adopted similar eligibility rules?

A: Yes, there are. We generally always have been very conservative when it comes to the safety of the donors and the safety of the blood supply. And we plan on still being conservative. A lot of these changes have actually been in place for quite a while  on the mainland, and I think sometimes it benefits us to not be the first to make these types of changes. It tends to be the larger blood centers that make changes first, and frequently they’ll publish articles in the literature about what’s happened and how it’s gone. Has it been safe for the donors? Have they noticed any adverse effects? Have they noticed any increase in positive test results or adverse reactions in the hospital? Since most of these rules have been in place for quite a while (elsewhere), there’s a good knowledge about it out there, so we feel even more comfortable. We don’t always want to be the first, on the forefront of changing things.

Q: You’re part of a national network, right?

A: We’re part of a couple of national groups. One is our major professional organization, AABB, as I mentioned, and we’re also a member of what’s called America’s Blood Centers, which is a grouping of community blood centers just like us.

Q: I’m assuming that on the mainland  those blood centers act like a market for blood, where they could trade blood if they needed it. Given our relatively remote location, is that possible in Hawaii?

A: It is possible. There are places to post (online) if people are running low on blood and would like to import. There’s also the same thing for people who have extra blood that they’re looking to export as well. We try to be as self-sufficient as we possibly can. 

There are times if usage is really, really high, maybe it’s just for one very specific patient, that we might look to import blood from the mainland just to help out our supplies temporarily. Other times it may be very unusual or rare blood types … or some specialized blood product that requires extensive matching and we might not have the donors here. 

Q: So the blood comes to you and you disperse it to the hospitals?

A: Yes, we do. Usually the hospitals will contact us, and, if we need to do something like that, then we … call blood centers that we know. Sometimes for certain types you know that certain blood centers are more likely to have those than others, and we can call them first. Other times you can post on a board where all the blood centers get these emails looking for different types and they can check their inventory and then get back to them. By the same token, sometimes we’re not the ones who are looking, but the ones who are helping other blood centers out. We are known nationwide for having some very rare types, where we have the largest number of donors right here in Hawaii.

Q: Like what?

A: The one that we’re probably best known for — we’ve even been written up in textbooks and journal articles — is a blood type called Jk3-negative. We have probably the largest number of those Jk3-negative donors of anywhere in the country. We screen all of our new donors for blood type and when we do have people of that blood type, we’ll actually freeze those red blood cells so that they’re good for 10 years. If we don’t need them right away, we’ll freeze them. First we make sure we can meet our own community needs, but we do get calls from all over the country looking for that type, and people know that if they need that type of blood, you want to call Blood Bank of Hawaii. So we’re not always on the importing end.

Q: Is there a racial or ethnic aspect to having that type of blood? Is it more common among certain populations?

A: Yes, it’s most common among Polynesians and people of Southeast Asian descent, as well as from Japan. So it fits in with our demographics and our donor population.

Q: What’s the most common blood type?

A: The most common is still O, followed by A. …

Q: When people donate blood that you are planning to use locally, how long is it usable? 

A: It depends on the product that we make. Plasma is the longest-lasting one, because that’s frozen, so it’s good for up to a year. Red blood cells are good for up to 42 days and the platelets are only good for five days.

Q: So you need regular donors to come back and replenish the supply?

A: Yes, we do. We generally need about 150 to 200 donors every day to meet the community needs. We also need about 7,000 new blood donors every year to replace the people who are no longer able to donate. …

Q: Are there predictable times of year where you know you’re going to need more blood?

A: Actually, there is some seasonality to blood use, and blood donation. We know that during the winter months, blood use tends to be higher and we tend to have higher donations during that time, and both tend to drop off a little bit when you get into the summer time. … We want to collect the right amount of blood. We don’t want to overcollect and have blood expire on the shelf, and we don’t want to undercollect and be short when a patient needs it.

Q: It’s a constant balancing act?

A: The need for blood exists every day. It never takes a vacation. We’re here to collect it and serve the community. One of the good things about being in Hawaii is the very giving culture. People here truly want to help one another. We certainly see that every day at the Blood Bank of Hawaii.