The Blood Bank

At Cook County Hospital there has been established a blood bank whereby staff members may deposit and withdraw donors blood in a unique system of preservation. The following notice has been issued to the staff physicians.
Notice to Medical Staff
“Hereafter an effort will be made to preserve by refrigeration blood to be used for blood transfusions. This method should accomplish two things: first, it should make blood available at any time it is needed; second, it should make the process of blood transfusion much more simple.
“It is obvious that one cannot obtain blood unless one has deposited blood. Staff physicians may deposit blood for credit at any time. A record will be kept of all blood credited to each service.
Depositing Blood
“Staff physicians will obtain from the Solutions Laboratory chilled 500 c.c. flasks, which will contain 70 c.c. of 2.5 per cent. sodium citrate solution. These flasks carry two test tubes for the collection of 5 c.c. of whole blood in each for the purpose of typing and for the Wassermann test. The blood will be drawn into the flask in the usual manner and taken immediately to the Solutions Laboratory. The date, the name of the donor, his address, his color, the name of the intern and his service should accompany the flask. By means of this system only one donor needs to be bled and he need not be typed, which greatly lessens the trouble occasioned by transfusion.
Keeping of the Blood
“In the laboratory the technician at once files it away in the refrigerator, which must maintain a constant temperature between 4 and 6 C., types it, tests if for sterility and the absence of syphilis, and credits it to the service that furnished the blood.
Drawing on the Blood Bank
Assuming that a patient needs blood transfusion, the house physician should secure from the patient 5 c.c. of blood, type it, and make out a requisition in proper form for the quantity and type of blood needed, which will be delivered to him from the refrigerator. It should be warmed by placing it in a water bath, the temperature of which would not feel too hot for the hand, and used immediately after warming.
Cross Matching Before Injecting
“The blood thus secured should be cross-matched with the patient’s blood by the resident who supervises blood transfusion. Not only should the corpuscles to be injected be matched against the patient’s serum, but the serum to be injected should be matched against the patient’s corpuscles. Owing to the possibility of serious allergic reactions, the blood of a patient allergic to horse serum should not be injected into a patient who recently had a horse serum injection. Repeated transfusions in which the same donor is used may give rise to anaphylactic shock.
Administration
While the hasty injection of blood may produce speedy death from ‘speed shock,’ the slow injection –literally drop by drop –has no such danger, even in disease conditions of the heart or lungs. Throughout the injection the patient should be carefully observed for any unfavorable reaction. The early and characteristic symptoms are ‘uneasiness’ in the chest, difficulty in breathing, excruciating pain in the back, and nausea. Failure to recognize these early symptoms may be responsible for a fatal result.
Dosage
“Overloading of the circulation must be avoided. In infants 20 c.c. of blood per kilogram of body weight should not be exceeded. In adults, after hemorrhage, the amount of blood required depends on the quantity lost. The loss of from 2,000 to 2,500 c.c. of blood may be fatal and save life in such a case. To increase coagulability of the blood, e.g., in hemophilia, a transfusion of 250 c.c. suffices.”
Sources of Blood
The main source of blood will no doubt always be the healthy volunteer donor, who service should be enlisted whenever possible. No matter what type blood the donor furnishes, the blood is sent to the laboratory, where it is exchanged for blood of the type desired. The advantage of the “blood bank” over the previous method is obvious. Only one donor needs to be bled, which dispenses with the commotion occasioned by calling to the hospital a horde of excited relatives before a suitable donor can be found.
A second source of blood is from patients with cardiac decompensation and those with excessive elevation of blood pressure, provided the patient is not suffering from infection, uremia or other toxemia. It should be a rule that practically all patients in need of digitalis should have a preliminary abstraction of blood to unload the heart before stimulating it.
A third source of blood is the antepartum clinic. Here the blood bank function of this project expresses itself most simply. We deposit in a bank money we do not at the moment need, to be able to draw on it when we do need it. In the same way a pregnant woman can easily spare a little blood a week or two before her expected confinement to have it saved for her against the time she may need it during or right after parturition. If she does not need this blood, it should become available for any ne who does.
There are some who seem to be n particular need of this antepartum blood. It is the premature child. Some pediatricians seem to be convinced that a premature infant who is not doing well is much benefited by the intramuscular injection every other day of 5 to 10 c.c. of blood of a woman who carries a child under her heart.
A patient who is to have an elec surgical operation could do no better than to deposit a week or two before the ordeal a pint of blood in the bank to have it available in case it is needed during or after the operation.
The bank may also function in the way of “lending” blood. Anyone who owes his life to blood transfusion clearly owes some blood to overcome else who is in great need of this restorative. This is eminently the case with convalescents from infectious diseases. In streptococcie sepsis, for instance, as well as in scarlet fever and probably also in influenza and many other infectious diseases, the blood of the convalescent is curative to the victim of the same kind of infection.
It should be the plain duty of the one who has recovered from such a disease to donate some of his blood to save the life of a fellow man in the hour of his desperate need. Surely one whose life has thus been saved owes some of his now curative blood to another victim of the same kind of infection. Opsonic index determinations on the preserved blood might permit one to predict in what kind of infection.
A Serum Center
The limit of blood preservation is lysis of the red blood components after their death. Obviously the trick of blood preservation in the enamel blood corpuscles to gather a “hibernation” stage on that, life processes being at a low, they many continue to live for a longer time than they otherwise would. The survival period of blood that preserved seems to be form three to four weeks. It is entirely probable that intensive research, which should at one be undertaken, may extend somewhat this blood corpuscle survival period. But sooner or later hemolysis sets in. With the appearance of the first traces of hemolysis the serum should be separated from the blood and the serum preserved –as it easily can be –for as long as time as may be necessary.
This will not only furnish a liberal supply of the so much needed human convalescent’s serum, but also of normal human serum with its natural immunizing and other therapeutic properties.
J.A.M.A. Per Medical World.