Plasma collection is a process in which blood is drawn from a donor and the plasma is separated by centrifugation to make biological products. This collection method began abroad in the 1940s and was popular until the 1970s.[1] In 1979, Professor Juanxiang Liu advocated the plasma collection method in China and the Ministry of Health officially approved its use. In 1982, the First National Workshop on Plasma Donation Experience Exchange was held by the Ministry of Health, and the use of plasma collection was promoted all over the country. People were worried, however, that the hurried promotion of this collection method would cause some safety issues. In 1984, the Ministry of Health arranged for Professor Juanxiang Liu and other experts to visit 22 plasma collection centers in 8 provinces, and a handbook, the Manual of Plasma Collection, was developed to standardize the process of the plasma collection. This was all done in order to ensure the well-being of the plasma donors,
the plasma recipients, and the staff working at plasma collection centers.[2]

Around the same time as plasma donation was introduced to China, the country ended its paid blood donation system and opted for an unpaid system. This was after nearly 30 years of instituting a paid system and the new system did not meet with much success because people had a difficult time understanding the point of the new system and did not readily accept it. As a result, paid blood donation persisted throughout the country. However, local supply could not meet demand. Almost all clinical blood products used at that time were imported because there were very few blood product enterprises in China. Then, in the early 1980s, the Ministry of Health, the Ministry of Foreign Trade and the China Quarantine and Customs Bureau jointly issued several notices banning the importations of blood and blood products, including plasma, albumin prepared from human plasma, and globulin.[3,4 and 5] This was in an effort to prevent HIV transmission through blood products. Given the existing reluctance to donate blood or plasma, the new regulations resulted in a shortage in the domestic supply of blood products. Thus, a blood/plasma economy emerged in the early 1990s. This was helped by increased importation of foreign capital, technology and equipment needed to establish blood product enterprises. Plasma collection centers sprang up all over the country as raw material providers, and this so-called blood/plasma economy came to be regarded as a kind of tertiary-industry which could help peasants make money, particularly in some poor areas. For example, at the peak of the industry, there were more than 200 registered plasma collection centers in Henan Province, and among which more than 30 were located in Zhumadian District.

Plasma collection comes with strict regulations, some of which are geared towards the donors themselves, such as how much plasma can be donated each time and how frequently an individual can donate.[1] In practice, however, many issues arose such as poor monitoring of adherence to the regulations by the collection centers and the donors. In order to promote the local economy, the local governments approved as many blood collection centers as possible and did not give due attention to the proper management of each site. Many collection centers focused on increasing profit margins and operated without respect to regulations and without regard for the safety of the donors. The process of blood collection in some of the illegal blood centers was done in very poor conditions, and the blood collection was often done in the donor’s home or even at the edge of the field where he/she worked. The donors did not undergo any testing before the blood collection. One blood bag had only one inlet tube, sealed using a hemostat. Ten shares of blood, collected from ten different donors, were injected into one blood bag. These ten shares of blood were then centrifuged to separate the plasma, the inlet tube was cut and the plasma was poured into a public plasma bag and sent to a biological products company as raw material. To prevent anemia in the donors, the rest of the red blood cells would be diluted with saline water and re-injected back into the donors intravenously- a process known
as plasmapheresis. Some blood collection center owners collected 450ml or 500ml of whole blood in one 400ml blood bag. Then the blood bags of same blood type were pooled into one big public blood bag for centrifugation. None of the equipment was disinfected during the procedure. One blood bag had only one pipe acting as both an inlet and an outlet, and many different donors used one public blood bag. All these factors easily facilitated contamination of the equipment with blood-borne diseases, including HIV.