Kenny Chesney packed a unit of his own blood in a red cooler in Roanoke on a cold morning in December. It was the kind of brittle cold that makes you cry, then freezes your eyelashes together with the tears. And it was the kind of red plastic cooler you’d find at Virginia Tech tailgates, except the top of this cooler was stamped BIOHAZARD. BLOOD USE ONLY was blazoned on the side.
Chesney has pink cheeks that Santa would envy, a perfectly clipped white beard, and 37 years of experience as a medical courier. He has spent the last three months as the supervisor of courier services for The Blood Connection, a nonprofit organization with over 20 community blood centers.
TBC supplies blood products to about 130 hospitals in Georgia, South Carolina, North Carolina, and now — with the opening of its two new blood collection centers in Roanoke and Danville — Virginia.
‘One big family’
In a low-slung building that used to be David’s Bridal, blood donors recline on black medical tables while phlebotomists in matching black scrubs wipe the inside crooks of their elbows with antiseptic before using sterile, disposable needles to collect blood into thick, clear pouches.
One pouch of blood is one “unit” — about a pint, the amount of blood a person can give in one “whole blood” donation. Each donation of whole blood can be separated into four components, such as red blood cells, and processed into different blood products. Therefore, one whole blood donation can help save two or more patients, according to America’s Blood Center’s 2024 report.
Both Sovah Health and Carilion Clinic will now get most of their blood products supply from TBC. At TBC’s grand opening in Roanoke on Dec. 10 — about an hour after Chesney packed blood into a cooler — Tim Auwarter, Carilion Clinic’s vice president of operations, said, “Our partnership is with The Blood Connection for our main blood supply, but we always work with Red Cross … It’s one big family.”
Big is the key word: Carilion Clinic used more than 19,825 units of blood products in 2024. In 2025, as of Dec. 10, Carilion had used more than 16,615 units of blood products. This means that meeting Carilion’s need for blood could take nearly 20,000 blood donations — 20,000 blood odysseys — a year. Each odyssey starts with a person volunteering to give about one-tenth of the blood in their body to someone they probably don’t know.
My recent donation took about six minutes from needle in to needle out. Jess Truax, a professional Santa Claus, Roanoke Regional Chamber of Commerce ambassador, and the work-based learning coordinator for Roanoke City Public Schools, might have beaten that. His strategy for making blood donation fun is to turn it into a challenge. He tries to give his blood faster than anyone else there. “I just view everyone around me. And if they sat down before me, I want to get up before they get up,” he said with a jolly, mischievous laugh — the heart of Santa, the mind of Odysseus.
Truax began donating blood over 30 years ago to help save his 10-year-old daughter. She needed open heart surgery to correct a birth defect. Today, Truax’s daughter is “doing great,” and he continues to donate blood because “you never know how your blood is going to be used, but you’re making life possible for someone in a critical situation who depends on that blood to survive.”
A storm of emergency need texts
Truax is part of the 3% of the age-eligible U.S. population who donate blood each year.
The percentage of eligible people who donate in Southwest Virginia is unclear. The American Red Cross was unable to provide donor statistics for their locations in Blacksburg and Roanoke.
However, the day after the TBC grand opening, my phone buzzed with a text from the American Red Cross: “EMERGENCY NEED: Hurry to give blood by 12/18=$15 Amazon eGift Card OR give 12/19-1/4=Red Cross tee, ltd qty!”
A few days later, on Dec. 16, an email from Red Cross popped up with the subject line: “EMERGENCY NEED + $30 gift cards – We need you now!” The email itself started with an exclamation point in a triangle, a symbol instantly recognizable as the warning light that illuminates in a car dashboard when something in the vehicle needs attention. The text of the email was highlighted in a red box — that bright shade of red not only for Santa’s cap and decking the halls, but also for signaling imminent threat: “Winter weather is causing a decline in donations. With more severe weather predicted, your important blood type is needed now to prevent a shortage.”
Then, on Dec. 19, I received an automated phone message from a Dr. Bioski at the Red Cross. She repeated the email’s warning about the weather-induced decline in blood donations. “As a physician, I know firsthand how important blood products are and why it is critical to always have them available. Your donation can give patients and their families a gift more meaningful than anything found in a store or purchased online.”
Was the blood supply in the New River Valley low? Was Southwest Virginia at risk of failing to supply patients with blood they need to live?
Do the messages mean that Carilion Clinic had less than one week of blood supply, the least amount stored at the hospital according to Auwater?
Were local blood banks on E?
The Association for the Advancement of Blood and Biotherapies reports that blood centers begin “alerting local donors” when the blood supply drops below a three-day level.
On Dec. 22 at approximately 11 a.m., about one-third of national and regional community blood centers had less than a three-day supply of blood, according to ABC’s online interactive map. In the map’s “south” region that includes Virginia, 4 of 12 (33%) blood centers included in the report had only 1-2 days of blood supply, 3 (25%) had at least a three days’ supply, and 5 (42%) were listed as N/A.
The ABC’s map provides only a partial picture of blood supply: Not all community blood centers in Virginia and the U.S. are included in the report or are members of ABC. For example, TBC is a member; American Red Cross is not. The names of the community blood centers that were included on the Dec. 22 midday report were not posted.
Another difficulty in determining whether blood supply was low in the New River Valley is that blood supply is dynamic. It constantly fluctuates. The supply goes up and down as blood comes in through donations and goes out through transfusions. Plus, donations vary significantly throughout the year. Two factors that can cause low donor turnout are winter weather and the holidays.
“Christmas and New Year’s is a really bad dead zone for blood donation. Any holidays, any bad weather — it’s hard to get people to donate,” said Dr. Claudia Cohn, chief medical officer of the AABB, professor at the University of Minnesota Medical School, and director of the University of Minnesota Blood Bank Laboratory.
Dave Graff, TBC’s public relations and marketing director, echoed Cohn: “The holidays are a time of peak need but lowest donation,” he said.
Southwest Virginia was in the midst of both holidays and winter weather during that series of emergency messages from the Red Cross.
However, at 10:43 am on Dec. 22, Carilion Clinic was “currently showing normal, maintained [blood] supply” according to an email from Hannah Curtis, external communications lead and public information officer for Carilion Clinic.
On that day, at that hour, Carilion Clinic’s blood supply was not on E.
The next day, on Dec. 23, another EMERGENCY NEED text message from the Red Cross arrived. On Jan. 14, a BLOOD SHORTAGE text from the Red Cross popped up. Neither of the two individuals contacted at the Red Cross could quantify the blood supply or speak to whether there was a particular shortage.
Blood donation and transport
After swiveling down from the black medical tables, donors at the TBC relax in a refreshment area stocked with an assortment of complimentary crackers, cookies, granola bars, sodas, water and coffee. Back in December there were even TBC-branded sugar cookies. December also featured special appreciation gifts for donors: a forest green TBC sweatshirt featuring a dog wearing a Santa cap, and a digital gift card that was more time-consuming to figure out than the donor screening questionnaire had been to complete.
In 2024, TBC collected 331,455 units of blood. TBC continues to grow and now, “We [TBC] need to collect 1,000 units of blood per day to meet the demands of hospitals we serve,” said TBC Partnership and Media Specialist Amaris Jenkins at the grand opening in Roanoke.
Inside the Roanoke center, members of the TBC phlebotomy team carry each pouch of blood from the collection room through a door to the back of the building. That is where Chesney packed blood on that bone-freezing morning of the grand opening. The back of the building is industrial. The white walls are blank. It feels stark after being in the collection room where the walls are covered with red, black and silver TBC branding and tenderly fuzzy gray-and-white photos about the gift of blood.
Chesney had donated blood at the Roanoke TBC the day before the grand opening: “[The entire process] took less than 20-30 minutes. Feel great today. Up early this morning,” he said, despite the fact that about a pint of blood that had been in his body the morning before was now in one of the pouches he was packing.
Chesney’s alert, cheerful eyes were as blue as his medical gloves. He vertically stacked 12 pouches of brownish-red blood, one at a time, on top of ice in the cooler. The amount of blood Carilion Clinic needs per year would fill 1,600 of those coolers.
Every single one of the TBC coolers needs to go from a collection center to a processing facility to a hospital. Unlike the unconscious flow of blood beneath the skin, the flow of blood out in the community requires conscious circulation. That conscious circulation is the responsibility of couriers.
Chesney didn’t know which pouch of blood was his. The labels don’t include donor names. But he did know exactly where the blood would be heading next: The cooler would be going from the Blue Ridge Mountains of Virginia to the North Carolina coast in a white truck driven by a supply chain logistics courier named Dean Townsend.
Townsend drives a staged, scheduled loop and focuses more on a checklist than on a visiting journalist. That morning he’d driven from a TBC processing facility in Kitty Hawk, North Carolina, to the Roanoke TBC collection center.
In the parking lot behind the Roanoke collection center, Townsend pushed red coolers of blood up a silver metal ramp into the back of a truck. Also in the back of the truck was medical equipment necessary for collecting blood, as well as various donor supplies — sweatshirts, peanut butter crackers, pamphlets about sickle cell disease.
From the Roanoke collection center, Townsend would drive to the other new TBC collection center in Danville, then back to Kitty Hawk.
Short shelf life, long journeys: Two routes essential to life
12,000 miles. That’s how far blood travels inside the human body — in a single day. That’s the equivalent of 1,500 round trips up and down McAfee Knob in 24 hours. That’s more than twice the distance from the football stadium at Virginia Tech to the Colosseum in Rome.
Blood’s journey through the 60,000+ miles of blood vessels in one body — enough to wrap around the Earth twice — happens automatically, without conscious control. Without any deliberate effort from the human being it’s keeping alive, blood cycles through the body about three times in one minute.
But outside the body, blood can’t go anywhere on its own. To make the journey from donor to recipient, blood — the fundamental courier of life — needs a courier of its own.
That’s where Chesney comes in.
Chesney’s route takes him from Kitty Hawk to Roanoke, then after 45 minutes in Roanoke preparing the blood for transport, on to Danville, then back to Kitty Hawk: “Not a bad drive,” he said of the nearly 700-mile trip.
It’s certainly less distance than blood travels within a human body in one day — but it’s just as essential. Whether or not there’s a blood supply shortage, the need for blood is always critical:
First, blood has a short shelf life. Red blood cells must be used within 42 days, and platelets must be used within 5-7 days. Second, donated blood must be processed and go through a slew of tests before it can be transfused. “The unit that’s donated today is going to be available for a patient maybe four days hence, so it’s a constant need to keep it going,” said Cohn.
Third, a steady regional blood supply is essential for disaster preparedness, including cyberattacks such as the one that knocked out a blood collection center in Florida in July 2024 necessitating “the entire country to mobilize and start sending blood down to Florida,” according to Cohn. Carilion Clinic may not be on E in terms of blood availability, but another hospital or blood center in the U.S. could be in an instant. Having a steady blood supply here in the New River Valley means that couriers can transport blood products elsewhere in case of an emergency.
Finally, there is no substitute for human blood. Cohn predicts that there could be a blood substitute in 50 years but that it won’t entirely replace blood donation. For now, if a person needs blood, the only way to fill that need is with donated blood.
The fact that blood cannot be manufactured contributes to the financial and moral complexities of an industry that needs to promote itself as a community in order to acquire donations of the inimitable, life-saving resource it supplies to people whose next breath depends on it.
Critical for cancer patients: ‘No one would know’
Cancer patients frequently need blood. In fact, approximately 25% of the blood supply goes to cancer patients. Blacksburg High School In-School Suspension Coordinator Dusty Spence has chronic leukemia and needs a blood transfusion about every eight weeks. Spence also has a genetic bleeding disorder called Von Willebrand disease.
Blood donations from anonymous donors keep Spence not only alive, but out of the hospital so that she can continue working with high schoolers. When Spence won a 2024-2025 LifeChanger of the Year Award, students presented her with a glass “Best Teacher Ever” bowl filled with 6,000 beads to represent each student she has taught through her career at Radford University, Virginia Tech, Fairlawn Christian Academy, Pulaski Youth Center and now Blacksburg High School.
“I’m tough — very tough. A girl was tardy and said her dog had cancer, and I said I have cancer — you can’t play the cancer card with me. I’m tough, but the kids rise to the occasion,” said Spence at the Fairview Starbucks on a windy Saturday morning the week before Christmas.
Spence’s sparkly garnet fingernails gleamed against the white ceramic mug of hot chocolate. Her eyes crinkled when she smiled — which was often — and she kept direct eye contact through the conversation. At one point, she took a Facetime call from her daughter who needed advice on a tricky dough for peanut butter pinwheels. The whirl of a mixer and squeals of babies — twin boys, Spence’s first grandchildren — spilled from the phone. “Be sure to flour the parchment paper good when you roll it. Good luck with it — bye.” Spence hung up: “I’m the baker of the family.”
After an hour of talking and laughing over hot chocolate, Spence held up her phone. She swiped through photos of her forearms and feet bruised from transfusions. She showed photos of her toenails. They, too, were bruised in purplish green, and cracked — “painful,” she said. “That’s why I have to keep my fingernails done [painted].”
For the first and only time in the conversation, Spence’s chin quivered. Her eyes brimmed with tears — tears that didn’t spill even she looked down to adjust her cardigan to reveal the words on her shirt — I’m just going to jingle a little bit because I’m tired.”
“I’m tired because I’m on chemotherapy,” she said. She took a big breath, “The biggest thing is you can’t even tell what someone else is going through. There have been days when —” another big breath — “sorry, the words are breaking, but no one would know.”
The mysterious cost of blood, and the hard costs of insurance
Spence receives most of her transfusions at the Blue Ridge Cancer Care in Blacksburg. The center did not respond to requests for information about its blood supply and blood management. Spence’s main concern, however, is not with the blood supply but with the cost: “It’s a constant fight with insurance because insurance only pays for three transfusions per year, but I need it every eight weeks,” she said.
Issues around the cost of blood products and transfusions are complicated. Hospitals in the U.S. pay an average of $234 for one unit of red blood cells, according to the CDC’s 2023 National Blood Collection and Utilization Survey. The average amount hospitals pay for one unit of platelets — the component of blood that helps with clotting — is $660.
Cohn of the AABB explained that red blood cells are sold for undercost — probably because of competition among blood collectors for contracts with hospitals — while platelets are sold for overcost “to make up for it.” American Red Cross and TBC declined to comment on how much they charge Carilion Clinic for a unit of blood.
And there’s no clarity on the cost to patients in Southwest Virginia. Carilion Clinic, Sovah and LewisGale all have online cost estimators. But the estimators are complicated and require, in this reporter’s experience, serious wrestling and squinting. There’s no straightforward, one-click answer to how much a patient has to pay for a unit of blood product.
For example, Sovah’s “Danville Hospital Charges Listing” is an Excel file with over 11,000 rows. As of Dec. 15, four charges were listed for one unit of red blood cells. The charges ranged from $1,093 to $3,021.
For help understanding the charges, I called the phone number listed “if you are unable to find a specific service.” The call was automated. I stayed on hold until prompted to leave a message. No one has called back as of Friday, Jan. 16.
In a 2023 study of 200 hospitals across the U.S., the average charge to patients for one unit of red blood cells was approximately $600. The average charge for a transfusion was approximately $2,000. But the authors of the study warned that their findings were limited because few hospitals provided pricing data, and the “chargemaster” files they did provide were often missing data or in unuseable formats. Apparently, the frustration I experienced wrestling with the Carilion, Sovah, and LewisGale cost estimators is common across the country.
Another frustration is trying to identify what happens to outdated blood. According to the 2023 National Blood Collection and Utilization Survey, outdated units of whole blood or red blood cells increased by nearly 14% from 2021 to 2023. “Carilion avoids out-of-date blood by returning it to The Blood Connection,” stated Peter Larkin, Carilion Clinic senior consultant for corporate communications. TBC has not responded to inquiries about outdated blood.
Testing and screening a precious, expensive resource
The lack of transparency about outdated blood and how much hospitals and patients have to pay for blood can cause distrust of the blood industry. Cohn acknowledges that convoluted pricing — such as differences in inpatient and outpatient transfusions — can cause distrust. However, she is quick to emphasize that the AABB considers itself a community, not an industry. “Blood,” she said, “is a precious resource — a precious resource that ends up being rather expensive.”
There are many costs — some of them not immediately obvious — in moving blood safely from one person to another. Those expenses include transporting blood hundreds of miles, like Chesney and Townsend do; testing the blood for blood type; screening the blood for multiple diseases, such as HIV and Babesia, a tick-borne illness present in Virginia; storing the blood at collection centers, processing centers, and hospitals; manufacturing the blood into components; labeling the blood; repeating blood type testing at the hospital; transfusing the blood with specific equipment; treating the 3% of patients who have an allergic reaction to transfusions; and conducting lookbacks to find previously collected blood from a donor who newly tests positive for an infectious disease such as hepatitis C.
Costs rack up: Each step of the blood collection and utilization process involves experts, such as physicians ordering blood and nurses performing transfusions. Each step also requires expensive equipment licensed by the Food and Drug Administration. Overall, Cohn emphasizes that much of a patient’s cost for blood is out of blood collectors’ control and that almost all blood collectors — such as TBC and the American Red Cross — are not for profit.
For profit or not, “We are the most regulated community aside from the airplane industry,” said Cohn. Odysseus had to comply with the gods; The Blood Connection and Carilion have the FDA.
The giving and receiving end
The meticulous level of quality control in blood transfusion impressed Lexington resident and retired businessman Steven Chapin. Chapin, who is 6’6 and played basketball for Virginia Military Institute, received life-saving blood transfusions at the University of Virginia Medical Center in 2023 when his blood pressure plummeted after surgery for a new popliteal artery in his lower leg. “I thought the transfusion was going to be just another IV, but it was a very intense, quality assurance process. It was not just another IV,” said Chapin.
Chapin himself donated blood for decades before he became a blood recipient. He started donating once a semester as a cadet at VMI in the 1970s. These days, according to a study conducted by two VMI economics professors, approximately 16% of VMI students donate blood, about double the proportion of 18- to 24-year-olds who donate nationwide.
When Chapin was at VMI in the 1970s, the cadet company with the highest participation in a blood drive got to skip morning inspection, including the daily chore of rolling up the mattress, securing it with straps and neatly placing it in the corner alongside the folded bed frame by 6:30 am.
At least a few times, Chapin — and other athletes — circumvented coaches’ preferences and donated blood the morning before basketball practice. “We were a little tired at practice, but nobody passed out,” he said with a slightly abashed yet warm chuckle.
Chapin, following in the footsteps of his father who was also a longtime donor, continued giving blood throughout his business career in Roanoke. About six times a year he’d walk down the street from his office to donate blood at the Red Cross during his lunch break. He even donated after a heart attack in 2015. “Being on the giving end was always very rewarding. Then being on the receiving end was humbling,” Chapin said.
The (un)conscious heart of circulation
Carilion Clinic receives deliveries of blood at two locations — Carilion Roanoke Memorial Hospital and Carilion New River Valley Medical Center in Radford. Most of Carilion’s blood supply is stored in a blood bank at CRMH, but each of Carilion’s six hospitals do have their own blood banks. Blood is also carried on Life-Guard helicopters.
Carilion Clinic is the only Level 1 Trauma Center in Southwest Virginia. To be designated as a Level 1 Trauma Center in Virginia, a treatment center “must have nearly every surgical and medical specialty available 24/7 to meet the needs of the most complex injuries a patient may sustain,” according to VCU Health.
Carilion has a Mass Trauma Protocol for treating actively bleeding patients who require several units of blood. Most of the blood at CRMH is delivered from the blood bank to the appropriate hospital floor through a pneumatic tube system that uses air pressure to rapidly propel a carrier through a network of tubes. However, when an MTP is announced, the Phlebotomy Department carries the blood in coolers to the hospital floor or Emergency Department.
The Emergency Department has a kiosk in a special room between trauma bays where nurses handle blood for trauma patients. “Carilion Clinic is committed to working closely with our blood services partner, The Blood Connection, to ensure that we’re prepared for patients who seek care at any of our hospitals,” stated Larkin.
The new TBC collection centers in Roanoke and Danville may help this region avoid blood availability problems that affect other rural areas. “Rural communities do not have equitable care when it comes to the amount of blood that’s available to them. The blood community is very aware of difficulty and inequity — terrible, terrible challenges as a result of infrastructure and economics — but blood is just a resource stretched thin,” said Cohn.
Carrying on through a winter storm
Unlike blood circulation within the body, maintaining community blood flow requires around-the-clock conscious effort from many people. The CRMH blood bank is staffed all day and all night, all year long, to monitor and control the blood supply. Likewise, the TBC’s team of 120+ professional couriers is available “24/7, 365 days a year,” said Chesney.
When snow and freezing temperatures hit the Roanoke area two days before the TBC grand opening, couriers like Chesney kept the blood supplies circulating. “We didn’t let it stop us,” he said.
On Jan. 24, another winter storm hit Southwest Virginia. Two days earlier, the Red Cross sent a “SEVERE SHORTAGE – Give Now” text message. Chesney, indicating the importance of blood flow regardless of weather, said “Without the donor, without the courier, without that connection — we’ve got no blood to offer people.”
The journey of blood has the complicated heroism, invisibility, geographics and economics of Greek myth and Santa lore. But, of course, there are no Muses and no magical workshops when it comes to local blood supply. Instead, there are miles — miles of veins, miles of highways, miles of different veins. The miles may be out of sight, the work of couriers like Chesney and Townsend unnoticed. But what they carry on allows others — a straight-talking teacher who loves her grandbabies and red velvet cake — to carry on, too.
January is National Blood Donor Month:
FAQs about the donation process
Where to donate blood – AABB’s search tool
Blood donations through The Blood Connection – Danville location
Blood donations through The Blood Connection – Roanoke location