Blood banking: Life in a bag

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Blood is life. Human beings know it well. Over the centuries we have bled many of our own to death. In Mythology and history, blood represents valour, kinship, revenge and vitality. For example, in Indian mythology, goddess Kali sucks entire blood of a demon, to prevent its regeneration. There is also a reference to blood-drinking in Mahabharata, when Bheem drinks blood of Dushasana to extract revenge. Egyptians used blood baths to regain youth. Romans would drink flowing blood of gladiators to become strong. Ancient physicians would advise blood-drinking for restoration of youth, and to cure insanity or epilepsy. Despite all this quackery around blood, all beliefs agree that flowing blood represents vitality. Once out of body it would simply clot and stop flowing. Hence, blood has or is a soul.

Early blood transfusions

William Harvey discovered circulation in 1628. Thereafter, various scientists became interested in blood-transfusions. Three decades later Jan Swanmerdam discovered red-blood-cells. Richard Lower performed first dog-to-dog transfusion in 1665. Enthused by this news, in 1667 Jan Baptiste Denis, a physician in France attempted first lamb-to-human transfusion. While first two patients survived these Xenotransfusions, third and fourth patients died. Subsequently, France, banned blood transfusions. Search for a blood substitute was ongoing. In early 19th century, some physicians started milk-transfusions, and obviously it was a failure. Saline transfusions started in 1884, and it was much more safe than milk !!

Karl Landsteiner and blood groups

Born in 1868, Karl Landsteiner became a doctor in 1891, and thereafter went on to study chemistry. He took a keen interest in cells and immunity. He discovered that on mixing blood of two human beings, sometimes it would clump. In 1901 he gave concept of blood groups A, B and C. Later scientists changed C to O (for Ohne in German for null). He went on to discover more blood-group types, including the Rh positive and negative groups. Today we regard Landsteiner as father of modern blood transfusion. He earned Nobel prize for his work in 1930.

Blood transfusions in early 20th Century

Ruben Otenberg, a US physician used Landsteiner’s discovery of blood groups and developed the practice of grouping and cross-matching. We perform this procedure even today, when we mix donor and recipient’s blood to see if it clumps. We discovered that blood group O could be given to anyone (universal donor), and a person with group AB could receive it from anyone (universal recipient). A person with blood group A or B had to receive it from the same groups. Despite this knowledge, transfusions were difficult.

Once blood was outside human body, it would clot. Hence physicians connected artery or a vein of a donor to the recipient, and blood would flow. There was no control over volume, or quality of transfused blood. Prior to First World War, these direct transfusions were mostly done as heroic a last resort. Need for direct transfusions led to development of vascular sutures. A French surgeon Alexis Carrel developed many of these techniques. He earned Nobel Prize in 1912.

Getting blood in a bottle

In 1914-15, scientists discovered sodium citrate. when mixed with blood, it allowed blood to remain as a liquid. This discovery was vital for establishment of blood-banks.

First blood-banks were setup in 1918, towards the end of the First World War. Blood banks adopted Landsteiner’s classification of blood-grouping. Now it was possible to get donated blood in a bottle, group it, and use it later when needed. Early blood banks were still limited, and used blood in extreme situations.

Second World War and blood donations

Second World War was terrible, but for blood-banking. Limited experience in 1930s had shown that blood transfusions saved lives of bleeding solders. During the Second World War, countries set up Blood Programs. Overall all countries collected about 13 million units of blood, stored and transported it to the front-lines and field hospitals. All nations encouraged blood donations in war effort. One of the slogans was “send your blood to the front-line”. War mortality reduced. In First World War every 10th solder brought alive to a field hospital died. In Second World War, this number was 4. Edwin Cohen, an American scientist discovered extraction of plasma in 1940. Blood was now a source for red-cells, plasma, as well as albumin. In 1943, we had better anti-coagulants, and could store blood for upto 20 days. Blood donations, and its separation into components continued on a larger scale in post-war period.

From bottles to bags

We invented plastic bags to store blood in 1950. However, use of glass bottles persisted in many countries till 1990s. Postage stamps in this period show both glass bottles and plastic bags.

All blood banks today store blood in bags, which makes it easy to store as well as to transport. One donor donates a bag of blood, which is about 300-350mL of life. We separate three components from each bag – packed cells, plasma, and platelets. This makes it three bags of life !!

Blood components

Earliest blood components – Plasma, albumin and Fibrinogen were available in 1940s. Of these, we used plasma as a source of all clotting factors. We developed technique of plasmapheresis in 1961. In 1962, we could further concentrate plasma as a cryoprecipitate. Thus, it was possible to treat patients with haemophilia with concentrated clotting factors. In 1972, we further perfected techniques for separating blood components or aphaeresis . Today we can separate multiple components, and put them to specific usages.

Making blood banks safe

Blood is life, polluted blood is not. Healthy donors are a healthy source of blood. We realised this early in course of blood banking. In 1947, blood-banks introduced mandatory testing for syphillis. Voluntary donors are healthier as compared to paid donors. In 1970, world moved to eliminate paid donors. We created societies for blood donation, to promote voluntary donations.

Today we test blood for various infections, and discard the bag once it is positive for any of these. We use these tests for hepatitis B (since 1971), HIV (since 1985), and hepatitis C (since 1990). We have improved testing for Hepatitis C and HIV further in 2002 by using nucleic acid based tests.

Civil societies and blood banking

Civil societies have a responsibility to make life-in-a-bag safe, and available to all those who need them. Today blood is lifesaving, not only to victims of war and trauma, but to countless mothers who have just given birth. It has improved lives of many children with blood disorders.

Blood products have made many complex surgeries possible. It has also improved treatment of cancers, and many other critically ill individuals.

Donating blood is altruistic. It is an anonymous donation, beyond caste, creed, race or religion. It is a unifying human experience, all of us should experience. 14th June is world blood donation day, a day to pledge safe-blood, donations, and humanism. Blood is life, in a bag.