Blood and Transfusion Centers

Blood transfusions are the most frequently performed procedure during hospitalization.(1) Since transfusion relies on individual donors, blood procurement procedures are common as well. Nearly 7 million people in the United States donate blood each year.(2) Given this statistic, you might think healthcare practitioners would be well-acquainted with blood procurement and transfusion; however, most of us lack knowledge on these subjects.(3) Physicians with an interest (whether they are pathologists or not) have career opportunities across various stages of the blood supply chain.

BLOOD PROCUREMENT

Blood donation centers ensure a reliable supply of blood products for transfusion. Most are nonprofit organizations that rely on volunteer donors. Together, the American Red Cross and America’s Blood Centers manage most of the blood supply. Other key organizations with national or regional presence include Blood Centers of America, ImpactLife, Vitalant, LifeSouth, and New York Blood Center.

Many centers primarily procure whole blood, although specialized facilities focusing on plasma donation are common. Plasma donation has advanced as an industry in itself due to high demand and profitability. Private, for-profit organizations run most plasma centers. Major players include BioLife Plasma Services, CSL Plasma, Grifols, Octapharma Plasma, and Plasma Centers of America.

Donation center physician oversight

Blood donation is a heavily governed series of processes, which significantly impacts the role of physicians.

FDA’s authority extends beyond food and drugs to include blood products. Requirements address donor eligibility criteria, screening and testing procedures for infectious diseases, proper collection and storage practices, documentation and record-keeping protocols, and adverse event reporting. Some states have additional requirements.

FDA uses the term responsible physician to refer to the physician who assumes overall responsibility for the medical aspects of the donation center’s operations. The physician does not always need to be present onsite, as some tasks can be conducted by phone. Certain duties can be delegated to a physician substitute working under the responsible physician’s supervision.

The Association for the Advancement of Blood & Biotherapies (AABB) accredits blood banks. Their standards similarly require that a center’s medical director have responsibility for all medical and technical policies and processes. Donation centers must also comply with the Clinical Laboratories Improvement Act to ensure accurate and reliable blood sample testing. This requires each center to have a qualified lab director.

These regulations and standards largely define the scope and nature of physician roles in blood donation centers. In many centers, a single physician is the responsible physician, lab director, and medical director.

Oversight tasks include reviewing policies and procedures, conducting chart reviews, and providing staff training. Physicians may be involved in donor evaluation, physical exams, and counseling in plasma centers. Since many responsibilities are delegated to phlebotomists, nurses, and medical lab technologists, centers often limit physician involvement as much as possible in order to control expenses.

The time commitment for a donation center physician may be as little as an hour or two per week. A few states impose certain requirements regarding the physician’s hours. Connecticut, for example, requires a doctor to be present at the center during at least half of its normal working hours.

BLOOD TRANSFUSION

Transfusion centers receive blood products from donation centers for storage and distribution. Many doctors never step foot in their hospital’s transfusion center; however, physicians are there, overseeing the entire transfusion process from patient evaluation to post-transfusion care.

A physician’s work in a transfusion center involves a combination of administrative duties, lab oversight, and patient care. Most tasks revolve around ensuring the appropriate and safe blood product use, such as through blood compatibility testing. They supervise specialized procedures like therapeutic apheresis, evaluate and manage transfusion reactions, and consult with other physicians on issues related to transfusions.

Blood banking and transfusion medicine intertwines medical knowledge, laboratory expertise, supply chain management, and quality assurance. It is one of the few pathology subfields that involves direct patient interaction and treatment.

PATHWAYS TO PRACTICING IN A BLOOD OR TRANSFUSION CENTER

Most blood banking and transfusion medicine subspecialists are pathologists; however, you do not need to be a pathologist to seek fellowship training and board certification in this field. The rationale for this is that many concepts and practices of transfusion medicine have relevance across multiple medical disciplines, including hematology/oncology, surgery, emergency medicine, and critical care. Board eligibility requires a 12-month fellowship. Not all fellowship programs accept applicants who are not trained in pathology.

One job in many blood and transfusion center jobs is lab director. Qualifications are based on the complexity level of procedures performed. Depending on your credentials, this may require a 20-hour, online CME course.

Although not required, it is fairly common for physicians in blood banking and transfusion medicine to hold a PhD. This is an option if you want more in-depth knowledge or research experience in molecular pathology, cytopathology, hematopathology, or another area of lab medicine.

Donation center physician qualifications

The FDA requires the responsible physician for a blood donation center to be licensed in the state in which the center is located and to be “adequately trained and qualified” to carry out their responsibilities.(4) It does not stipulate what “adequately trained and qualified” means. Similarly, AABB requires the donation center medical director to be “qualified by training, experience, and facility-defined relevant continuing education” but does not specifically state what training or experience is acceptable.

Some states have strict rules about the qualifications for a donation center medical director. California, for instance, requires at least six months experience in blood banking methods, transfusion principles, and transfusion practices. In Connecticut, medical directors must have at least one year of training or experience in blood banking or be board-certified in pathology.

Donation centers or the corporations running them may set additional requirements for their medical directors. Some require physicians to be board-certified in blood banking and transfusion medicine, while others do not.

COMPENSATION

Pathologists earned an average salary of $357,384 in 2022.(5) Even the most in-depth physician salary surveys fail to provide a breakdown of compensation for blood banking and transfusion medicine subspecialists.

Hourly rates for contracted medical directors at blood product donation centers range from about $100 to $300 per hour. Experience, prevailing market rates, scope of responsibilities, and other factors influence this figure.

Excerpted from 50 Unconventional Clinical Careers for Physicians (American Association for Physician Leadership, 2024).

References

1. Pfuntner A, Wier LM, Stocks C. Most Frequent Procedures Performed in U.S. Hospitals, 2010. HCUP Statistical Brief #149. February 2013. http://www.ncbi.nlm.nih.gov/books/NBK132428/

2. American Red Cross. U.S. Blood Supply Facts. Accessed October 14, 2023. https:// www.redcrossblood.org/donate-blood/how-to-donate/how-blood-donations-help/blood-needs-blood-supply.html

3. Lin Y, Khandelwal A, Kapitany C, Chargé S. Transfusion Camp: Successes and Challenges in Scaling and Expanding a Transfusion Medicine Education Program. Transfus Apher Sci. 2023 Feb;62(1):103629.

4. U.S. Government. Requirements for Blood and Blood Components Intended for Transfusion or for Further Manufacturing Use. Vol 21 CFR Part 630. https://www.ecfr.gov/current/title-21/part-630

5. Doximity & Curative. 2023 Physician Compensation Report. Accessed November 3, 2023. https://press.doximity.com/reports/doximity-physician-compensation-report-2023.pdf