Yo, Blood! We Got Next

The person in the first row standing to the right of the man with the ball is Charles Richard Drew (1922). Dunbar High School, Washington D.C.   

“In athletics, he [Drew] later noted, one learned to meet and overcome all kinds of challenges, to subordinate self for the good of the team. By fighting on and knowing that others had won similar battles, an athlete developed the confidence essential to facing life's other challenges.”  - https://profiles.nlm.nih.gov/ps/retrieve/Narrative/BG/p-nid/337

In 1928, two years after having graduating from Amherst College, Charles Drew decided to pursue his interest in medicine and enrolled at McGill University in Montreal, Canada. He was received as a member of the Medical Honorary Society and graduated in 1933 with Master of Surgery and Doctor of Medicine degrees, finishing second in his class of 127 students. Drew’s interest in blood transfusion medicine began during his internship and surgical residency at Montreal Hospital (1933-1935) working on ways to treat shock (a critical medical condition resulting in a drop in blood pressure as the circulatory system fails to maintain adequate flow, sharply curtailing the delivery of oxygen and nutrients to vital organs), with fluid replacement.

Blood

 

Blood is the body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the cells and transports waste products away from those same cells. Blood is circulated around the body through blood vessels by the pumping action of the heart.

In humans, blood is composed of blood cells suspended in blood plasma. Plasma, which constitutes 55% of blood fluid, is mostly water (92% by volume), and contains waste material, glucose (sugar), mineral, proteins, hormones, and blood cells themselves.

The blood cells are mainly red blood cells (RBCs), with lesser amounts of white blood cells (WBCs) that help to resist infections and parasites, and platelets (small colorless disk-shaped cell fragments involved in clotting). The most abundant cells are RBCs. These contain hemoglobin, an iron-containing protein, which facilitates oxygen transport and gives blood its red color.

Human blood is divided into various types based on the presence and absence of antibodies (a protein produced mainly by plasma cells that is used by the immune system to neutralize bacteria and viruses) and also based on the presence or absence of inherited substances on the surface of red blood cells (RBCs). The A-B-O system is the most important blood-group system in humans.

The RhD system (Rh comes from the Rhesus monkey where this factor was first isolated) is noted as plus or minus) is the second most significant blood-group system. The two blood group systems were discovered during early experiments with blood transfusion: the ABO group in 1901 and the Rhesus group in 1937.

Sometimes people need more blood than they have due to loss because of an accident, inherited condition, or for the requirements of surgery. They need transfusions of blood or blood related substances to survive. Given that there are different types of blood, not every person can give blood to be transfused into every other person. If a unit of incompatible blood is transfused between a donor and recipient, kidney failure and shock is likely to occur, and death is a possibility. 

Much of the routine work of a blood bank involves testing blood from both donors and recipients to ensure that every individual recipient is given blood that is compatible.

Type O- person can donate blood to a person in any one of the other major blood groups. Type AB+ person can receive blood from any other blood groups. For any other person in one of the other blood groups, there is a varying degree of compatibility.

 

In many situations, the need for transfusions can be satisfied through the use of plasma rather than whole blood. The comp ability level between people for plasma is higher than for whole blood because the RhD typing is no longer critical. This can be the difference between life and death for those persons with B- or AB- blood who, in some situations, may not have access to donors from their group.

Plasma compatibility is the inverse of red blood cell compatibility. Type AB plasma carries neither anti-A nor anti-B antibodies and can be transfused to individuals of any blood group; but type AB patients can only receive type AB plasma. Type O carries both antibodies, so individuals of blood group O can receive plasma from any blood group, but type O plasma can be used only by type O recipients.

As with many other genetic traits, the distribution of A-B-O and RhD blood groups varies significantly between populations. This variation is generally not well correlated with our everyday and frequently misguided classifications of people.

Generally, a person’s blood type is not publically known, former President Barack Obama was AB- so that when travelling, special care was taken to insure a proper supply of his relative rare (as you can see from the above chart), blood type was available should he have required it.

 

Transfusion Medicine

 

The first blood transfusions were made directly from donor to receiver before the blood began to coagulate. The initial publication of a successful human to human transfusion is credited to James Blundell, a British obstetrician in 1818.

 

Six years after the identification of the A-B-O blood typing in 1901, American Ludvig Hektoen suggests that the safety of transfusion might be improved by cross-matching blood between donors and patients to exclude incompatible mixtures.

 

The first non-direct (where blood was drawn and then time passed before the donor received it) transfusion was performed in 1914. The First World War acted as a catalyst for the rapid development of blood banks and transfusion techniques.

 

In 1915, anticoagulants, among them sodium citrate (Na3C6H5O7), are developed, allowing longer preservation of blood. It takes 10 years for sodium citrate use to be accepted. Later that year, the feasibility of refrigerated storage of such anticoagulated blood is demonstrated.

 

By 1918 the use of blood plasma as a substitute for whole blood for transfusion purposes was being proposed. It should be noted, that as was in the case of anticoagulant, that it takes time between the recognition of a phenomenon, the testing of that discovery to insure that the finding are correct and then the adoption and or the implementation of the technique/delivery system for it to become part of standard medical procedure.

 

In 1932, the first blood bank, a center where blood gathered as a result of blood donation is stored and preserved for later use in blood transfusion is established in what is today, St. Petersburg, Russia.

Charles Richard Drew

As the concept of blood banking was developing, Drew was completing his internship and surgical residency at Montreal Hospital (1933-1935).

In 1935, he returned to the United States and began working as an instructor of pathology (the science of the causes and effects of diseases), at Howard University in Washington, D.C. He was also a resident at Freedmen’s Hospital (the teaching hospital for Howard University) and was awarded the Rockefeller Foundation Research Fellowship.

Developments in the field of blood were moving quickly and the RhD factor type was discovered in 1937. RhD mismatch was found to be the cause of the majority of bad transfusion outcomes prior to that time.

 

Drew spent two years at Columbia University in New York attending classes and working as a resident at the Columbia University Presbyterian Hospital. At Columbia, he wrote a dissertation on “Banked Blood” in which he described a technique he developed for the long-term preservation of blood plasma. This breakthrough overcame the problem of whole blood storage which at that time could not be stored for more than two days because of the rapid breakdown of red blood cells. 

Plasma is a blood component that is a clear yellow liquid containing various proteins and electrolytes that carries blood cells and other substances through the body. It can be used as a blood substitute to help replace fluids and treat shock. There is an advantage to using plasma over whole blood in emergency situations because it:

  • keeps longer without refrigeration

  • won't deteriorate when agitated during transport

  • can be used with any blood type

  • is much less likely to transmit diseases

  • in large doses, it can be injected through veins, and muscles

To separate plasma from blood cells, the team used centrifuging (separation of blood components by density) and sedimentation (separation of particles from a liquid).

Drew had discovered that by separating the plasma from the whole blood (in which the RBCs exist) and then refrigerating them separately, they could be combined up to a week later for a blood transfusion. He also discovered that while everyone has a certain type of blood (A, B, AB, or O) and thus are prevented from receiving a full blood transfusion from someone with different blood type, the compatibly pattern for plasma negated the RhD issue and as was eventually discovered, the reverse of that of whole blood.

                               Plasma Type Compatibility                                                                        Blood Type Compatibility                                                                                                                                                                                                      (without RhD typing)

 

Thus, in certain cases where a whole blood transfusion is not necessary, it was sufficient to give a plasma transfusion which could be administered to anyone, regardless of their blood type.

 

He convinced Columbia University to establish a blood bank and soon was asked to go to England to help set up that country’s first blood bank. Drew became the first Black to receive a Doctor of Medical Science degree from Columbia and was now gaining a reputation worldwide.

 

In 1938, Drew won a fellowship to train at Presbyterian Hospital in New York with eminent surgeon Allen Whipple. Instead of following the traditional path of residents to gain experience in surgical pathology and bacteriology, surgical laboratory research, outpatient clinic, operating rooms and surgical wards, Whipple assigned Drew to work under John Scudder, who was granted funding to set up an experimental blood bank. This would prevent him from privileges afforded to his white peers, especially direct access to patients. Whipple would later be won over by Drew’s talent, supporting both his surgical training and doctoral research.

 

Drew and Scudder focused their research on diagnosing and controlling shock, fluid balance, blood chemistry, preservation, and transfusion — the work on which he based his seminal dissertation, "Banked Blood: A Study in Blood Preservation." Drew’s doctoral research assessed previous blood and transfusion research, blood chemistry and fluid replacement, and evaluated variables affecting shelf-life of stored blood — from types and amounts of anticoagulants (substances that prevent blood from clotting) and preservatives, to shapes of storage containers and temperature.

His key findings, complex procedures, and standards for collecting, processing and storing blood proved his expertise and led to an appointment to head the Blood for Britain Project (BFB), an effort to transport desperately needed blood and plasma to Great Britain, which was then under attack by Germany.

 

The blood collection program was initiated in the US in 1940. Beginning in August of thaT YEAR, it collected blood in New York City hospitals for the export of plasma to Britain. Drew worked with Doctors Scudder and E. H. L. Corwin to plan the organizational process of safely collecting, processing and storing large amounts of contamination-free plasma along with procedures for extracting plasma and ensuring safe arrival in Britain.

 

The plasma was then pooled from a collection of eight bottles using an anti-contamination technique under strict air and ultraviolet lighting conditions. An anti-bacterial called Merthiolate (C9H9HgNaO2S) was added to the blood product and batches were tested weekly.

 

A dried plasma package was developed, which reduced breakage and made the transportation, packaging, and storage much simpler. The resulting dried plasma package came in two tin cans containing 400 cc bottles. One bottle contained enough distilled water to reconstitute the dried plasma contained within the other bottle. In about three minutes, the plasma would be ready to use and could stay fresh for around four hours.

 

Finally, each batch was transferred to a shipping container and diluted with sterile saline solution. A final sample for bacteria-testing was taken before the containers were sealed and packed. By early August of 1940, a trial shipment of plasma was sent to England and confirmed "entirely satisfactory."

 

In the midst of the Blood for Britain project, Drew passed the American Board of Surgery exams. “In surgical circles, Drew's performance on the oral part of the exam, in which he confidently lectured his examiners about fluid balance and management of shock, became as legendary…” 

When the program ended in January 1941, Blood for Britain collected 14,556 blood donations, and shipped (via the Red Cross) over 5,000 liters of plasma saline solution to England.

Charles R. Drew was able to transform the test tube methods into the first successful mass production technique. This type of plasma was widely used by British and American forces throughout WWII and on into the Korean War.

The program became a model for the Red Cross pilot program to mass-produce dried plasma in New York in February 1941, with Drew as assistant director, and later for the National Blood Donor Service. Among his innovations were “bloodmobiles” — mobile blood donation trucks with refrigerators.

The work sealed his reputation as a pioneer and earned him the title, “father of the blood bank.”

Charles Drew (first on the left) with the first mobile blood collecting unit, February 1941

Ironically, the Red Cross excluded African Americans from donating blood, making Drew himself ineligible to participate in the very program he established. That policy was later modified to accept donations from blacks, however the institution upheld racial segregation of blood, which throughout the war Drew openly criticized as “unscientific.” He resigned his post after the United States War Department issued a directive that blood taken from White donors should be segregated from that of Black donors.

In 1941, Drew returned to Howard University, where he remained for the next nine years serving as Head of the Department of Surgery and Chief of Surgery at Freedmen's Hospital. His mission was to “train young African American surgeons who would meet the most rigorous standards in any surgical specialty” and “place them in strategic positions throughout the country where they could, in turn, nurture the tradition of excellence.” This he believed would be his “greatest and most lasting contribution to medicine.”

Charles Drew died on April 1, 1950 when the automobile he was driving went out of control and turned over. Drew suffered extensive massive injuries but contrary to popular legend was not denied a blood transfusion by an all-White hospital – he indeed received a transfusion but was beyond the help of the experienced physicians attending to him. His family later wrote letters to those physicians thanking them for the care they provided. Over the years, Drew has been considered one of the most honored and respected figures in the medical field and his development of the blood plasma bank has given a second chance of live to millions.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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In the U.S., certain standards are set for the collection and processing of each blood product. Most blood for transfusion is collected as whole blood. Donations are sometimes transfused without further modification, however whole blood is typically separated (via a centrifuge) into its components, with red blood cells (RBC) in solution being the most commonly used product. Units of WB and RBC are both kept refrigerated at 33.8 to 42.8 °F (1.0 to 6.0 °C), with maximum permitted storage periods of 35 and 42 days respectively.

Routine blood storage is 42 days or 6 weeks for stored packed RBCs It is by far the most commonly transfused blood product, and involves refrigeration but usually not freezing.

Whole blood or blood with RBC is transfused to patient. It can be stored at 1.0°c-6.0°c for 35-45 days.

Plasma transfusion - Fresh Frozen Plasma can be stored at a very low temperature of -25°C for 12 months. The less-dense blood plasma is made into a variety of frozen components, and is labeled differently based on when it was frozen and what is the intended use. If the plasma is frozen promptly and is intended for transfusion, it is typically labeled as fresh frozen plasma.

For any questions, please contact David Trotman :

415-298-8979

1519 O'farrell St. San Francisco, CA 94115