the give and take of blood banking

cover story
The give
and take of
blood banking
By Carren Bersch, Editor
A
CO N T I N U I N G e D U C A T I O N
To earn CEUs, see current test on pages 18-19 and at
www.mlo-online.com under the CE Tests tab. The CE test covers
all material in the Cover Story section except the Blood timeline.
LEARNING OBJECTIVES
Upon completion of this article, the reader will be able to:
1.Be aware of blood donation requirements and statistics.
2.Recognize infectious-disease risks of donated blood.
3.Identify most needed blood types.
4.Be familiar with different rules for military transfusions.
March 2010
Would-be donors banned
While these “feel-good” stories of regular and even enthusiastic donors give the impression that America has no donor
problems, nothing could be further from the truth. Out of its
estimated 309 million citizens, the United States had only 9.5
million donors in 2006.2 While approximately 37% of the U.S.
population is eligible to give blood, only 5% actually donate,
while the number of transfusions nationwide increases by 9%
every year.2,4
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month from now, retired Air Force Staff Sgt. Dennis
Provencher will make his way to the American Red
Cross Center on Camp Foster in Okinawa to donate yet
another pint of his blood. In 2004, Guinness World Records
recognized him as having donated more blood than anybody
else. “I challenge anyone to catch me,” he told Stars and
Stripes on Feb. 12.1
As with all blood donations, Provencher’s is separated into
packed red blood cells, fresh frozen plasma, and platelets — any
unit of which could technically save someone’s life. He enlisted
in the Air Force in 1951 in his home state of New Hampshire,
and has donated blood since his transfer to Okinawa in 1961.
A radio operator during his service, Provencher says he fell in
love with the island and its people; he extended his assignment
long enough to retire there in 1971.1
According to the American Red Cross, if a person begins
donating blood at age 17 and donates every 56 days until he
reaches 76, he will have donated 48 gallons of blood, potentially helping save more than 1,000 lives.2 At 76, Provencher
has given 34 gallons of blood in the last 46 years. He is one of
a small band of long-term blood donors.1
An Ohio man, Alan Whitney, makes a habit of donating
platelets and is now working his way across the country to get
the word out that others, too, should donate. Whitney undertook
his goal to donate in all 50 states, starting in Pennsylvania in
2007; and on Feb. 10, Oregon was his 35th. He sat in a chair
to donate platelets for the 647th time at age 71, having been
a volunteer in blood banks in one form or another for the past
45 years.3
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In the world of blood-donor collection, certain people are
denied from time to time, or permanently, the opportunity to
give blood. Despite technological advances and the precautions to ensure a safe blood supply, for example, federal policy
permanently denies homosexual men, intravenous drug users,
or anyone who has been paid for sex from donating blood. The
Food and Drug Administration (FDA) — the organization responsible for federally regulating the blood supply — adopted
the policy in 1983 to reduce the risk of transmitting HIV/AIDS
via blood transfusion.4 Among other blood-related organizations, the American Red Cross has denounced the ban, calling
it “medically and scientifically unwarranted because all donated
blood has undergone testing since 2007.”5
At the University of South Dakota (USD), blood drives have
been a joint operation with the Siouxland Community Bank and
the Sioux Falls Community Blood Bank. During the 2008-2009
school year, USD donated 628 units of blood, but members of
the campus 10% Society complained that the policy is not fair
since, in the words of a freshman student, “For this ban to make
sense, it would have to be a ban of all sexually active people
and even then, there is a chance of failure.” San Jose State
University announced in 2008 that the FDA policy violated the
school’s non-discrimination policy regarding sexual orientation,
thus, there would be no more school-sponsored blood drives.
Several other universities have followed suit.5 The FDA has
not changed its rules; and from time to time cites the fact that
it would if given data that showed doing so would not pose a
“significant and preventable” risk to blood recipients.6
Diseases that preclude donation
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Other groups are also banned from donating blood, such as those
whose blood may carry diseases other than HIV/AIDS. In years
past, blood donors discovered to have hepatitis B antibodies
were warned that a second positive test result would disallow
their continued participation. Perhaps 200,000 Americans have
been banned from giving blood because of repeated falsepositive tests for hepatitis B, according to the FDA. In the late
1980s and the 1990s, as many as 21,500 Americans were turned
away every year because of false-positive hepatitis B tests, but
the FDA proposed allowing some people who initially test positive for hepatitis B to donate. A new test for hepatitis B is much
more specific. People who test positive on the first test could be
tested again eight weeks later with the more specific test. If that
test is negative, they would be allowed to donate blood.7
The United States also banned blood donations from people
who spent six months or more cumulatively in Britain between
1980 and 1996. The ban was employed when speculation spread
that a British man who received blood in 1997 and developed
variant Creutzfeldt-Jakob Disease (vCJD or “mad cow disease”) six years later may have contracted it from an infected
transfusion.8 Despite little evidence at the time that new variant Creutzfeldt-Jakob Disease might be transmitted by blood
or plasma, an FDA advisory panel voted in 1999 to prohibit
donations from that category of people.9 vCJD transmission
via blood transfusion was finally confirmed in 2003.
Cutaneous Leishmaniasis,or L Major was a concern during
large-scale 1990 and 1991 U.S. military operations in Saudi
Arabia, Kuwait, and Iraq and was, at one time, listed by the
U.S. Army Medical Research and Development Command as
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a possible health threat to U.S. troops in Somalia. Persian Gulf
veterans were banned from donating blood in the early 1990s.
The fear that Leishmania tropica, a parasite transmitted by sand
flea (Phlebotomus papatasi) bites, could be spread through
transfusions, prompted a14-month ban for these veterans,
beginning Nov. 12, 1991.10
In 2003, the World Health Organization diagnosed more
than 200,000 citizens of Kabul, Afghanistan, with Cutaneous
Leishmaniasis. Late that year, the FDA held a blood-banking
seminar to discuss the possibility of contamination of the U.S.
blood supply by Leishmaniasis. It was there that the FDA
decided a lifetime ban on blood donations from persons from
Iraq diagnosed with Leishmaniasis should be imposed, because
there is no guarantee of a 100% sterile cure of any version of
Leishmaniasis. Later, the Pentagon made the same policy for
U.S. troops.11
The recession finds a drop in blood donations
The American Red Cross says the number one reason donors
say they give blood is because they want to help others; the two
most common reasons cited by people who do not give blood are
they never thought about it or they do not like needles.2 During
the past year, blood donations have fallen low enough to prompt
directors of various blood banks to tap into national stockpiles
through the busy spring season. Florida is one example. Because
of the recession, blood drives at Florida businesses — normally
suppliers of approximately 40% of the blood used at local
hospitals — have dropped substantially. Many businesses have
closed or had substantial layoffs. Those that have not closed
have fewer employees left to donate.12
Florida’s blood shortages are linked to the recession, even
though the nation’s blood supply remains adequate. In some areas of the state where seasonal visitors to RV parks are recruited
for blood drives, previous donors have not made the annual trek
to the Sunshine State because of the economy. Some Florida
blood banks are now making trips to high schools where ad
campaigns encourage younger donors, since state law allows
students as young as 16 to give blood. Currently, teens make
up 10% of the state’s blood supply.12
Facts about blood donation
According to the American Red Cross, type O-negative blood
(red cells) can be transfused to patients of all blood types; it
is always in great demand and often in short supply. Only
7% of people in the U.S. have O-negative blood type. Type
AB-positive plasma can be transfused to patients of all other
blood types; AB plasma is also usually in short supply, since
only 3% of people in the U.S. have the AB-positive blood type.
The blood used in an emergency is already on the shelves before
the event occurs.2 Statistics show that 25% or more of us will
require blood at least once in our lifetime.4
The upside to regular blood donation includes a miniphysical with each visit to the blood bank. Many blood banks
offer childcare, on-site bloodmobiles, or convenient parking.
Whole blood donation only takes approximately 45 to 60
minutes.4 Donating blood is a safe, simple four-step process:
registration, medical history and mini-physical, donation, and
refreshments. A sterile needle is used only once for each donor
and then discarded.2 Because there is a lag time after exposure
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B L OO D B A N K I N G
Walking blood banks: screening blood in the battlefield
By Col. Francisco J. Rentas, Maj. David A. Lincoln, Lt. Cmdr. Corey R. Jenkins,
Lt. Col. Robert J. O’Connell, and Maj. Robert G. Gates
C
are for severely injured combat casualties relies heavily
on blood product transfusion.1-3 Fresh whole blood (FWB)
has been used in many military conflicts to resuscitate
casualties. Its use in civilian settings is limited due to the wide
availability of fractionated components derived from whole
blood and provided for specific indications. In combat, blood
requirements may exhaust pre-screened component therapy
supplies, and in other cases, needed components may be
unavailable at a particular location.4 In these settings, FWB
may be the only source of blood components available for
the management of hemorrhagic shock and its associated
coagulopathy in casualties. The physician practice of collecting and transfusing FWB supports hemostatic-resuscitation
techniques performed in concert with aggressive surgical
control of bleeding. This is a clinical decision usually made
in the middle of a mass casualty.
Current and evolving trauma doctrine emphasizes broad distribution of medical assets to allow rapid initiation of damagecontrol resuscitation and surgery.5 There is little doubt that the
proximity of emergency care to casualties has contributed favorably to low combat-fatality rates during the current conflicts
in Iraq and Afghanistan.6 Geographic dispersal, however, adds
to the already challenging, immense, and intermittent demands
that may prevent adequate provision of blood components
which have been pre-screened for transfusion-transmitted
disease (TTD) pathogens in accordance with the U.S. Food and
Drug Administration (FDA)-approved standard of care.
When there are not enough properly screened blood
products available to care for casualties arriving at military
treatment facilities during combat, U.S. military doctrine
allows the use of unscreened (by U.S. FDA standards),
voluntarily donated, and freshly collected blood products to
save patient lives. Donors for emergency blood collections
are usually military members who are co-located with the
medical unit at the time of need, more commonly referred to
as “the walking blood bank.”
Current Clinical Practice Guidelines in Iraq and Afghanistan,
clearly state that it is not appropriate to use FWB as an alternative to more stringently controlled blood products for patients
who do not have severe, immediate life-threatening injuries.
Fresh whole blood is to be used only when other blood products
are unable to be delivered at a rate to sustain the resuscitation
of an actively bleeding patient, when specific stored blood
components are not available (e.g., pRBCs, platelets, Cryo, FFP)
or when stored components are not adequately resuscitating
a patient with an immediate life-threatening injury.
Since the need for FWB cannot be predicted, a contingency operational plan is developed by the medical staff to
include the laboratory/blood bank, and surgical and anesthesia providers. If practical, a pre-screened donor pool using the
blood donation questionnaire and pre-testing for all required
FDA transfusion-transmitted disease markers is performed.
The safest donor candidate is one with recent laboratory
www.mlo-online.com
confirmation of blood group/type and no evidence of TTD.
In addition, where feasible, on-site testing of potential
blood donors using rapid screening assays for infectious
diseases (i.e., HIV, HBV, and HCV) is performed before FWB is
transfused. Regardless of whether rapid testing is performed
pre- or post-transfusion, these tests are not licensed for donor
screening, and samples must be sent to a reference laboratory for FDA-approved blood-donor testing. A mechanism is in
place to ensure both the recipient and donor can be notified
should the results be positive for infectious disease. In fact,
all U.S. recipients of FWB in theater are required to be tested
initially and at three, six, and 12 months after transfusion according to current policy.
In an emergency, ABO/Rh of donors may be established via
local testing or previous donor history. Identification tags (“dog
tags”) for ABO/Rh verification should be utilized as a last resort
only. Retrospective testing for infectious-disease markers is
performed on all donor specimens. This testing is completed at
an FDA-approved, Department of Defense-sanctioned laboratory in accordance with FDA and AABB standards. In addition,
several countermeasures are required of potential blood donors of blood products collected in theater in the U.S. military.
These include HIV force screening of all military personnel
every two years, HIV theater-entrance screening 90 days prior
to deployment, and compulsory hepatitis B vaccination.
The use of FWB has been independently associated with
improved survival of patients and will continue to have a place
in combat-casualty care.7 Current TTD countermeasures and
risk-mitigation strategies will continue to be evaluated for
improvement. This includes continued evaluation of quick and
effective rapid-test methodologies that are sensitive, specific
and, hopefully, FDA-approved for donor testing in the future.
Col. Francisco J. Rentas, Maj. David A. Lincoln, and Lt. Cmdr. Corey R. Jenkins,
are located at the Armed Services Blood Program Office in Falls Church, VA.
Lt. Col. Robert J. O’Connell is with the Department of Retrovirology at Walter Reed
Army Institute of Research in Rockville, MD, and Maj. Robert G. Gates is located at
the Dwight D. Eisenhower Army Medical Center in Augusta, GA.
References
1. Beekley AC. Damage control resuscitation: a sensible approach to the exsanguinating surgical patient. Crit Care Med. 2008;36:S267-274.
2. Blackbourne LH. Combat damage control surgery. Crit Care Med. 2008;36:S304-310.
3. Perkins JG, Cap AP, Weiss BM, Reid TJ, Bolan CD. Massive transfusion and
nonsurgical hemostatic agents. Crit Care Med. 2008;36:S325-339.
4. Kauvar DS, Holcomb JB, Norris GC, Hess JR. Fresh whole blood transfusion:
a controversial military practice. J Trauma. 2006;61:181-184.
5. Burris DG, Rich NM, Sturtz DL. Surgical research at the Uniformed Services
University: one graduate’s perspective—from student to Chief, Division of
Surgical Research. Mil Med. 2004;169:97-101.
6. Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system
development in a theater of war: Experiences from Operation Iraqi Freedom and
Operation Enduring Freedom. J Trauma. 2006;61:1366-1372; discussion 72-73.
7. Spinella PC, Perkins JG, Grathwohl, KW, Beekley, AC, Holcomb, JB. Warm Fresh
Whole Blood Is Independently Associated With Improved Survival for Patients
With Combat-Related Traumatic Injuries. J Trauma. 2009;66:S69-76.
MLO  ■  March 2010
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before infectious-disease tests become
positive, all donors are also questioned
closely about possible recent exposure
to infectious diseases.11 After blood
is drawn, it is tested for ABO group
(blood type) and RH type (positive or
negative), as well as for any unexpected
red blood cell antibodies that may cause
problems for the recipient. Screening
tests are also performed for: ±± hepatitis B surface antigen (HBsAg);
±± hepatitis B core antibody (anti-HBc);
±± hepatitis C virus antibody (antiHCV);
±± HIV-1 and HIV-2 antibody (antiHIV-1 and anti-HIV-2);
±± HTLV-I and HTLV-II antibody (antiHTLV-I and anti-HTLV-II);
±± serologic test for syphilis;
±± nucleic-acid amplification testing
(NAT) for HIV-1 and HCV;
±± NAT for West Nile virus (WNV) (this
test is not required by the FDA); and
±± anitbody test for Trypanosoma cruzi,
the agent of Chagas’ disease (this test
is also not required by FDA).13
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The Red Cross’ fact sheet cites
statistics that more than hint at the
importance of volunteer donors: Every
two seconds someone in the U. S. needs
blood, and more than 38,000 blood donations are needed every day. More than
80,000 sickle-cell patients can require
blood transfusions throughout their
lives. More than 1 million people are diagnosed with cancer each year, many of
whom need blood during chemotherapy
treatments. A single car-accident victim
can require as many as 100 pints of
blood. 2 The Centers for Disease Control
and Prevention says the U.S. blood supply is the safest in the world. But blood
cannot be manufactured — it can only
come from generous donors.2
References
1. Orr M. Retired airman on Okinawa holds Guinness
World Record in blood donation. Stars and Stripes.
February 13, 2010: http://www.stripes.com/article.
asp?section=104&article=67978. Accessed February 15, 2010
2. American Red Cross. Blood Facts and Statistics.
http://www.redcrossblood.org/learn-about-blood/
blood-facts-and-statistics. Accessed February
15, 2010.
3. Hintze H. Ohio Man Donates Blood Platelets in
35 States. KEZI.COM 24/7 Nonstop News. http://
kezi.com/healthwatch/162190. Accessed February 15, 2010.
4. Mayo Clinic. Did You Know? http://www.mayoclinic.
org/donate-blood-rst/know.html. Accessed February 15, 2010.
5. Goetzinger N. Gay men still banned from giving
blood. Volante Verve. February 10, 2010. http://
www.volanteonline.com/verve/gay-men-stillbanned-from-giving-blood-1.2146337. Accessed
February 15, 2010.
6. The Associated Press. FDA says gay men still
can’t donate blood. http://www.msnbc.msn.com/
id/18827137/print/1/displaymode/1098. Accessed
February 15, 2010.
7. USA TODAY staff. A better life: Morning rounds:
Giving blood, discriminating against fat people.
http://blogs.usatoday.com/betterlife/2008/05/
nearly-15-of-bl.html.
8. Ault A. FDA bans UK blood donation. Nature Medicine. 5;720(1999). doi:10.1038/10429
9. Food & Drug Administration. http://www.fda.gov/
BiologicsBloodVaccines/BloodBlood/QuestionsaboutBlood/DonatingBlood/default.htm. Accessed
February 15, 2010.
10.Gunby P. Desert Storm Veterans Now May Donate
Blood; Others Call for Discussion of Donor Tests.
JAMA. 1993;269(4):451-452.
11.Leishmaniasis in Iraq from the Gulf War to OIF.
http://www.gulflink.org/Leishmaniasis/leish.htm.
Accessed February 15, 2010.
12.Scott A. Drop in blood donors linked to recession.
February 1, 2010. Sarasota Herald-Tribune. P. 1.
13.AABB. Blood Donation FAQs. http://www.aabb.
org/Content/Donate_Blood/Blood_Donation_FAQs/
Accessed February 15, 2010.
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Blood timeline
c. 500 BCE: Alcmaeon, Croton, Greece, observes when he dissects animals that
arteries and veins are dissimilar.
c. 400 BCE: Hippocrates suggests the body is comprised of four humors:
blood, phlegm, black bile, yellow bile. Further, imbalance among the four
humors causes disease. Hippocrates and his followers set out principles
forming the basis of much of Western medicine, including physicians’
adherence to a strict ethical code of conduct.
c. 350 BCE: Aristotle believes that the heart is the central organ of the
body and — based on his dissections of different animals — a threechambered organ, even in humans.
300 BCE: Herophilus of Chalcedon, one of the first Greek anatomists to publicly
dissect human cadavers, determines arteries are thicker than veins and carry
blood.
c. 130-200 BCE: Galen [Claudius Galenus], one of the most important and influential
physicians next to Hippocrates, dissects and experiments on animals, proving
arteries contain blood. Galen suggests that arteries and veins are completely
distinct. His ideas form the core of the medical canon for centuries.
mid-1200s: Ibn al-Nafis, physician and author from Cairo, Egypt, discovers and
describes the flow of blood to and from the lungs: pulmonary circulation.
1553: Spanish physician and theologian Michael Servetus refutes Galen’s theory by suggesting blood flows from one side of the heart
to the other via the lungs instead of through the wall between
the ventricles.
1628: British physician William Harvey publishes Anatomical Treatise
on the Movement of the Heart and Blood in Animals; he explains that
blood circulates within the body and is pumped by the heart.
1674: Unaware Swammerdam and Malpighi, Anton van Leeuwenhoek, a Dutch linendraper-turned-microscopist, provides a more precise description of red blood cells,
approximating their size to 25,000 times smaller than a fine grain of sand.
1771: In Experimental Enquiry into the Properties of the Blood, British anatomist William
Hewson details his research on blood coagulation. He succeeded at arresting
clotting and isolating a substance from plasma he called "coagulable lymph," now
known as fibrogen, a key protein in the clotting process.
1795: A footnote in a medical journal credits Philadelphia physician Philip
Syng Physick for performing the first human-to-human blood transfusion.
1881: British obstetrician and physiologist James Blundell performs the first
recorded human-to-human blood transfusion. Using a syringe, he injects a patient
suffering from internal bleeding with 12 to 14 ounces of blood from several donors.
The patient dies after initially showing improvement.
1874: Sir William Osler observes small cell fragments from bone marrow make up
the bulk of clots formed in blood vessels; these will come to be called platelets.
1901: Austrian physician Karl Landsteiner publishes a paper detailing his discovery
of the three main human blood groups: A, B, and C (he later changes C to O). He
charts the regular pattern of reaction that occurs when he mingles the serum and
red cells of an initial set of six blood specimens. Red cells agglutinate when serum
from group A is mixed with the red cells of a second group B. Similarly, group B
serum causes the red cells of group A to agglutinate, but the red cells of a third group
C never clump when mixed with the serum of group A or B. Based on these results,
he deduces that two different types of antibodies exist to cause agglutination, one
in group A, another in group B, and both together in group C.
1902: Alfred von Decastello and Adriano Sturli (Landsteiner’s colleagues) identify
fourth blood group: AB that causes agglutination in red cells of groups A and B.
1658: Jan Swammerdam, a 21-year-old Dutch microscopist, is thought to be the
first person to observe and describe red blood cells.
1907: Dr. Ludvig Hektoen of Chicago recommends checking the blood of donors and
recipients for signs of incompatibility (or cross matching) prior to transfusion. At
Mount Sinai Hospital in New York, Dr. Reuben Ottenberg performs the first transfusion using cross matching and, over the next several years, successfully uses the
procedure in 128 cases, virtually eliminating transfusion reactions.
1661: Italian anatomist Marcello Malpighi observes through a rudimentary microscope, the capillary system.
1914: Almost simultaneously, Albert Hustin of Brussels and Luis Agote of Buenos
Aires discover that adding sodium citrate to blood will prevent it from clotting.
1665: Richard Lower in England performs the first recorded blood transfusion in animals. With a crude syringe of goose quill and bladder, he connects the jugular vein
of a dog he has bled to the neck artery of second dog, resuscitating the former.
1915: Dr. Richard Lewisohn at Mount Sinai Hospital in New York formulates the
optimum concentration of sodium citrate that can be mixed with donor blood to
prevent coagulation but pose no danger to the recipient:.2%. Dr. Richard Weil
determines that citrated blood can be refrigerated and stored for a few days and
then successfully transfused.
1667: In June, French physician Jean-Baptiste Denis transfuses a
teenage boy suffering from a persistent fever with nine ounces of
lamb's blood. He attaches the lamb's carotid artery to a vein in the
boy's forearm, without the patient suffering any negative consequences.
He uses the procedure on several other patients, until Antoine Mauroy,
dies after two transfusions of calf’s blood in December. In 1668, Denis
sues Mauroy's widow for slandering his reputation. In 1670, the case
prompts the French Parliament's ban on all transfusions involving
humans. In England and Rome, similar actions are taken.
1667: Before the Royal Society in England, Drs. Richard Lower and Edmund
King give Arthur Coga, an indigent former cleric, a transfusion of several
ounces of sheep's blood for a fee of 20 shillings; the patient recovers nicely.
1916: At the Rockefeller Institute in New York, Francis Peyton Rous and J.R. Turner
develop a citrate-glucose solution that allows blood to be stored for a few weeks
after collection and still remain viable for transfusion.
1917: While serving in the U.S. Army, Dr. Oswald Robertson, familiar with the work of
Drs. Rous and Turner, collects and stores type O blood with citrate-glucose solution
in advance of the arrival of casualties during the Battle of Cambrai in World War
I. Thereby, he establishes the first blood depot.
1922: Percy Lane Oliver begins operating a blood-donor service out of his home in
London. He recruits volunteers who agree to be on 24-hour call and to travel to local
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B L OO D B A N K I N G
hospitals to give blood as the need arises. Volunteers are screened for
disease, tested for blood type; names are entered into phone logs, so
volunteers can be quickly contacted when blood is required.
1930: On March 23, at the Sklifosovsky Institute in Moscow, Dr. Serge Yudin is the
first to test the efficacy of transfusing humans with cadaver blood. He successfully
resuscitates a young man slashed both his wrists attempting suicide by injecting
him with 420 cc of blood from a cadaver of a 60-year-old man, who died after being
hit by an omnibus. The Soviets are the first to establish a network of facilities to
collect and store blood for use in transfusions at hospitals.
1935: Anesthesiologists at Mayo Clinic in Rochester, MN, organized a transfusion
service in 1933 and are now the first to store citrated blood and utilize it for transfusions within a hospital setting in the U.S.
1936: In August during the Spanish Civil War, Physician Federico Duran-Jorda
establishes the Barcelona Blood-Transfusion Service. The service collects
blood, tests it, pools it by blood group, preserves and stores it in bottles under
refrigeration, and with vehicles fitted with refrigerators, transports it to frontline hospitals. At the same time, Canadian surgeon Dr. Norman Bethune,
a volunteer with the Republican Army, organizes a similar mobile blood
service in Madrid: The Spanish-Canadian Blood Transfusion Institute.
1937: Dr. Bernard Fantus coins the term "blood bank" to describe the blood donation, collection, and preservation facility he starts as director of Therapeutics at
Cook County Hospital in Chicago, IL.
1939: Drs. Philip Levine and R.E. Stetson uncover an unknown antibody in the blood
of a woman who has given birth to a stillborn, and postulate that a factor in the fetus’
blood, inherited from the father, triggers the antibody production in the mother.
1940: Drs. Karl Landsteiner and Alex Wiener discover the Rh blood group,
through experiments with the red blood cells of Rhesus monkeys, and
identify the antibody found by Levine and Steston to be anti-Rh. Meanwhile,
a plasma shortage in Britain during World War II prompts the U.S. to organize
the Plasma of Britain campaign, run by Dr. Charles Drew from a central laboratory at Presbyterian Hospital in New York. Building on techniques
already developed to separate and preserve blood plasma, which is a
viable substitute for whole blood, Dr. Drew devises a modern and highly
sterile system to process, test, and store plasma for shipment overseas
by the Red Cross. At the same time, searching for a durable substitute
for liquid plasma, Harvard biochemist Edwin Cohn invents a method to separate
out its different proteins or fractions. In a series of steps that are repeated, with
slight variations in temperature and chemical conditions, plasma is mixed with the
solvent ethyl alcohol and centrifuged. Through this process dubbed fractionation,
Cohn and his team are able to isolate the plasma components fibrinogen (Fraction
I), gamma globulin (Fraction II and III), and albumin (Fraction V). Each of these
fractions are thought to contain different therapeutic properties, with albumin
holding the most promise.
1941: In January, at the behest of the Surgeon General of the U.S. Army and
Navy, the American Red Cross agrees to organize a civilian blood donor
service to collect blood plasma for the war effort. The first center opens
in New York on February 4, and the Red Cross collects over 13 million units
of blood over the course of the war. Philadelphia surgeon Dr. Isidor Ravdin
successfully treats victims of the Pearl Harbor attack with albumin to increase
blood volume.
1943: In his report in the Journal of the American Medical Association, Dr. Paul
Beeson links the occurrence of jaundice in seven cases to blood or plasma
transfusions the patients receive a few months prior, providing the quintessential
description of transfusion-transmitted hepatitis.
1947: As an alternative to the Red Cross blood centers being set up across the
country in the post-war period, directors of independent, community blood banks
join together to form a national network of blood banks called the American Association of Blood Banks.
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1948: Dr. Carl W. Walter, a trained surgeon, develops a plastic bag for the collection of blood which revolutionizes blood collection. Glass bottles — fragile
and susceptible to contamination — prompted him to devise a stronger, more
portable plastic container.
1959: Through the use of X-ray crystallography, in which X-rays are beamed
on crystals to reveal the distribution of their atoms, Dr. Max Perutz working at
Cambridge University, England, is able to unravel the structure of hemoglobin,
the protein within red blood cells that carries oxygen.
1965: Dr. Judith Pool, an American physiologist at Stanford University, discovers that slowly thawed frozen plasma yields deposits high in Factor VIII (or
Antihemophilic Factor). The deposits called cryoprecipitates (or cryo) are found
to have much greater clotting power than plasma and given to hemophiliacs to
stop bleeding episodes. It prevents the need for hemophiliacs to travel to the
hospital to be treated, since cyro can be kept frozen at home and infused, after
being thawed, by a physician.
late-1960s: Drs. Kenneth M. Brinkhous of the University of North Carolina at
Chapel Hill and Edward Shanbrom of Hyland Laboratories produce a highly
concentrated form of Factor VIII by pooling large quantities of plasma that
generate vast amounts of cyro, which are then redissolved, treated, filtered,
and centrifuged. The resulting powder's clotting power is 100 times stronger
than raw plasma, easily stored in a portable vial, and can be injected with a
syringe by hemophilia patient.
1971: Dr. Baruch Blumberg of the National Institutes of Health (NIH) identifies
a substance on the surface of the hepatitis B virus that triggers the production
of antibodies. His work leads to the development of a test to detect the presence of hepatitis B antibodies, thereby identifying infected donors; the test is
mandated by the FDA.
1981: The first cases of a syndrome initially called Gay-Related Immunodeficiency
Disease (GRID), due to its prevalence among gay men, are reported. It is later
renamed Acquired Immune Deficiency Syndrome (AIDS).
1982: When hemophiliacs also begin to develop GRID, Dr. Bruce Evatt, a specialist
in hemophilia at the Centers for Disease Control and Prevention (CDC), begins
to suspect that the syndrome may be blood borne and presents his theories at a
meeting of a group of the U.S. Public Health Service in July.
1983: Researchers at Dr. Luc Montagnier's lab at the Institut Pasteur, in France,
isolate the virus that causes AIDS. They locate it in the swollen lymph node in
the neck of a Parisian AIDS patient and label it lymphadenopathy-associated
virus (LAV).
1984: Dr. Robert Gallo of the NIH announces that he has identified the virus that
causes AIDS, which he calls (human T-cell lymphotropic virus (HTLV III).
1985: After dozens of Americans are infected with AIDS from blood transfusions,
the first blood-screening test to detect the presence or absence of HIV antibodies
— the ELISA test — is licensed by the U.S. government on March 2. The test is
universally adopted by American blood banks and plasma centers. A legal battle
over who deserves credit for the discovery of the AIDS virus finally ends in 1987
when the U.S. and French governments agree to share credit and royalties from
the sales of test kits for the virus.
1987-2002: A series of more sensitive tests are developed and implemented to
screen donated blood for infectious diseases: two tests that screen for indirect
evidence of hepatitis; the Human T-Lymphotropic-Virus-I-antibody (anti-HTLV-I)
test; the hepatitis C test; the HIV-1 and HIV-2 antibodies test; the HIV p24 antigen
test; and Nucleic Acid Amplification Testing (NAT) that directly detects the genetic
material of viruses like HCV and HIV.
Note: The material contained in this history was extracted from Red Gold: The
Epic Story of Blood in the Blood History Timeline at http://www.pbs.org/wnet/
redgold/history/index.html on February 15, 2010.
MLO  ■  March 2010