Reflections On A Red Cross Donor Card

A few days ago, I was cleaning out my wallet, removing some of the detritus of the past year. It's almost embarrassing to see how much useless stuff that I have been carrying around. Anyway, among the items I found was my Red Cross Blood Donor ID card. I've been an RC donor since the early 70s. According to the RC records, in the 31 years or so that I have lived in Michigan I have donated 80 units of whole blood. I have always donated several times a year, and in recent years I have often hit the legal limit of five donations a year.

One of the reasons that I donated so regularly (besides the fact that it's just a good thing to do) was that I have an O Negative blood type. Only about 8% of the population is O Negative, but the really valuable thing about that type is that it makes me a 'universal donor'. That is, pretty much anyone needing blood could take my O Negative blood regardless of what their type was. Every time I donated, I would be reminded of my 'specialness'. Frequently, the RC would also send snail-mail reminders, which always mentioned the need for O Negative blood.

I really didn't mind donating at all. Unlike some of my fellow donors who became faint or dizzy after a donation, I never had any trouble at all. Instead, I always looked forward to the cookies and juice they provided in the 'recovery' area after a donation. Even more valuable to me was the fact that donating presented a good excuse to get out of the office.

This happy situation lasted until about two years ago, when I began having serious health problems. Around Thanksgiving 2004, I contracted a nasty cold/flu of some sort that I just couldn't shake. The RC rules are that if you have an active infection, you aren't supposed to donate. Unhappily, this infection lasted for many weeks, frustrating several scheduled attempts to go donate.

In a previous post, I warned that I might get tiresome talking about the following subject, so don't say I didn't tell you. Going into 2005, the cold/flu thing continued, but I also started developing other unpleasant symptoms. This prompted a number of rounds of doctor's visits to figure out what was happening. Finally, on March 10, 2005, I learned that I had contracted multiple myeloma, a serious bone marrow cancer. The day after I got the diagnosis, I started some heavy chemotherapy, which then continued for a number of months. Later I had a couple of bone marrow stem cell transplants. All of this high-intensity medical activity undoubtedly saved my life, but it also meant that I would never again be able to donate blood.

Rather, over the course of the months following the initial diagnosis, it turned out that I needed to receive a number of blood transfusions. Although I don't think I have received 80 units back, I know I have put a good dent in that number.

There were several reasons I needed the blood. At first, I was suffering anemia simply because my bone marrow was full of cancer cells instead of normal tissue, and so I was not producing enough red blood cells. At the time of my diagnosis, my bone marrow consisted of 70% cancer cells. It was no wonder that I felt tired and out of breath all the time.

As I mentioned, I went through a lot of chemotherapy, which killed a lot of the cancer cells. Then, in preparation for my first stem cell transplant in August 2005, I received a massive dose of a chemotherapy agent called melphelan. This drug killed even more of the remaining cancer cells. However, it also killed off most of the healthy cells in my bone marrow. (This was actually part of the plan for the transplant.) After that treatment, I then received an infusion of my own previously harvested bone marrow stem cells. From those cells, I regrew new bone marrow tissue. Naturally, that took some time, so I needed a few transfusions to bolster my red blood cell supply before my newly regenerated bone marrow could get back on the job.

Finally, in October 2005 I received a second stem cell transplant, using stem cells donated by my sister Bliss. This time there was no preliminary 'conditioning' or 'induction therapy' (kinder, gentler terms for chemotherapy). I simply received an infusion of her stem cells. Over the course of some days, those cells found their way into my bone marrow and set up shop.

It took many months, but eventually my sister's stem cells, which were healthy and vigorous, supplanted my own weakened cells. I don't remember exactly when it happened, but after a number of months the DNA tests the lab did on my blood showed that I was '100% donor cells'. Even more interesting, and perhaps amusing, was the wording in a July 7, 2006 cytogenetic analysis report:

The presence of a normal female karyotype in this sample is consistent with the engraftment of cells from a female donor following peripheral blood stem cell transplantation.

In other words, the transplant had been a complete success. My bone marrow was a clone of my sister's, and the blood cells it made were just like hers. It almost looks like a sex-change operation for blood cells. I like to joke that if I ever commit a crime, and leave some blood at the scene, the cops will be looking for a woman. (Someone else pointed out that this would make an interesting plot device for a CSI episode. But I digress.)

There was one niggling detail to spoil this medical success story. My sister was a perfect tissue match for me, as measured by the usual way that one does such matching. However, she had an A Positive blood type. I mentioned earlier that having O Negative blood made me a universal donor. Unfortunately, given the way blood type matching worked, that also meant that I could only receive O Negative blood. This more stringent matching requirement also included new blood cells generated in my own body.

So, while my new bone marrow was busily making new A Positive red blood cells, what was left of my old immune system was promptly killing them off because they were not O Negative. The left hand giveth, while the right hand taketh away, and all that. My new bone marrow was apparently producing plenty of new blood cells, but they never got a chance to do much good before they got wiped out. That meant that I had to keep getting O Negative blood transfusions.

This problem started right after the transplant in October 2005 and went on for a number of months. I received several treatments aimed at correcting the mismatch, but they took a long time to have an effect. Frankly, I was beginning to wonder if I was going to have a permanent problem with this internal blood type mis-match. The prospect of needing blood transfusions in perpetuum was not a happy one for me (or our insurer, I'd bet).

However, right around the end of May 2006, the old immune system finally gave up the ghost, and stopped killing off my new blood cells. When that happened, my hemoglobin level, which had been hovering in the 6-8 range for months, shot up to the 14-16 range, which is normal for an adult male.
(Perhaps you can't quite make out the numbers and dates on the axes of this graph, but hopefully you can see the sharp rise from late May to early July.) Needless to say, we were pleased. In fact, we were overjoyed. I haven't needed a transfusion since that rise. (The graph also shows a little bump around mid-October, but that's a different story.)

This brings me to the insight that flashed through my mind when I pulled out my RC donor card. Ever since the ABO blood typing system was first figured out by medical researchers, a person's blood type was thought to be immutable. Yet, now we know that under the right circumstances, it can change. What other characteristics of a person that we think of as fixed and unchanging are actually mutable, given the right conditions?

I have a friend, a very successful businessman, who fits the classic profile for a Republican supporter. He in fact was a Republican, as evidenced by his financial donations and his participation in party events. Yet, in the years since Bush's election, he has done a complete 180° politically. He now actively (and financially) supports various Democratic candidates, and debates his still-Republican pals in a friendly, but vigorous way. Knowing him as long as I have, I was rather surprised by the switch. Yet for him, the change was necessary, even unavoidable. He was repeatedly and increasingly distressed by the actions of the current Administration, as well as by numerous Republican misdeeds in his own state. As Popeye put it, "That's alls I can stands, 'cause I can't stands no more".

We have all been surprised by people we thought we knew well who did something completely unexpected. A confirmed bachelor finally gets married. A couple we thought had been happily married for decades gets a divorce. A well-known religious figure who had railed against immorality turns out to be a pedophile and porn addict. A hard-core atheist becomes a fervent believer and evangelist.

We may view some of these changes as unfortunate, or even tragic. Other changes, particularly those of a religious or ideological nature, are often viewed with suspicion. Those who disagree with a person's new views are likely to see him as a traitor or a 'flip-flopper'. However, it seems to me that the very notion of free will doesn't mean very much unless it allows the possibility of a person making this kind of deep, fundamental change. And you have to admit that resisting obviously needed change is just self-destructive: staying the course was definitely a bad idea for Captain Ahab.

In many things I am a conservative, in the older sense of being predisposed to limiting change. However, as I grow older, I am coming to appreciate the value, even the necessity, of allowing and accepting change in others, and especially in myself. After all, if I can change blood types, then who knows what other kinds of changes I have in my future?