Enhance Patient Outcomes
“The Physician is only nature’s assistant” -Galen
The Recent Development of Banking Human Blood:
1937- Bernard Faustus, director of therapeutics at Cook County Hospital in Chicago, founded the first blood bank in the United States. He developed the novel concept of preserving and storing donor blood. Fantus originated the term “blood bank.” The understanding and acceptance on the utility of maintaining stored human blood quickly blossomed to community blood banks being formed across the United States.
However, it quickly became apparent that donor blood could not be treated with a cavalier attitude in regard to patient population. The rejection factor was elusive and perplexing, initially appearing to be without resolution. When an allergic reaction did occur, it was presented as an anaphylactic reaction- an extreme allergic reaction to a foreign protein. This reaction could easily become so severe, the patient may quickly expire.
1939/40- A group of physicians actively searching out a mechanism to overcome common rejections of donor blood were extracting red blood cells (erythrocytes) from rhesus monkeys to obtain the first blood serum. It was during this process they discovered the “Rh process” (Rh for Rhesus).
The Rh blood group discovered by two separate individuals developed two separate nomenclatures. Ronald Fisher, along with R.R. Race were one group. Wiener was the other. Both factors represented alternative theories of inheritance. The Fisher-Race system was based on the theory of separate genes that control the product of each corresponding antigen.
The Weiner system utilized the Rh-Hr nomenclature. This was based on the theory of one gene at a single locus on each of two copies of chromosome 1, each contributing to the production of multiple antigens. Today, notations of the two theories are utilized interchangeably in blood banking. Modern DNA testing confirmed that both theories are partially correct.
Hemolytic disease of the newborn:
This condition occurs when there is incompatibility between the blood types of the mother and fetus. There is also potential incompatibility if the mother is Rh negative, and the father is Rh positive. When the mother conceives for the first time, with a positive child, she will become extremely sensitive. When any comparability is detected during conception for the second time in less than two years, the mother often receives an injection at 28 weeks’ gestation and at birth in an effort to avoid the development of antibodies towards the fetus. If not given, the baby will be dead and must be aborted.
Frozen Blood and the Vietnam War:
The Vietnam War, or as the spin Doctors within the Eisenhower Administration chose to frame it “Vietnam Conflict,” in a macabre way, was the perfect breeding ground for new ideas. The unfortunate hubris from all these word games lies in the fact that the United States was aware of the massive defeat France suffered earlier in Vietnam and the Panama Canal. However, the egomaniacal caretakers in Washington could never fathom nor admit defeat. There was one glowing logistical reality with Vietnam that was never mentioned publicly or in Washington. Banked human blood and hot humid weather do not mix.
Stretching from 1954 to 1975, the war caused the deaths of hundreds of thousands of soldiers and as many as two million civilians. At the same time, this was the first war in which injured individuals benefited from the lifesaving medical innovation of preserving blood by freezing it.
The logistical difficulties of maintaining a constant source of fresh human blood for transfusion were monumental and nearly impossible in a non-refrigerated wartime environment. Refrigerated fresh blood is viable for only about 21 to 30 days, and the need to change suddenly with the fluidity of combat and evacuation of wounded to military hospitals for necessary transfusion was extremely difficult at best.
Dr. Charles Drew, an African-American Los Angeles California physician during the 1930s broke down the different components of blood. The resultant blood plasma could be safely stored for two months- a major breakthrough and God sent to hospitals in Vietnam at the time.
A second major breakthrough due to necessity during Vietnam was developing the ability to freeze red cells in a protective compound of glycol. This provided the mechanism to freeze cells derived from whole blood that remained viable for up to 10 years.
Blood and blood products as the vehicle for transmitting HIV:
Acquired immunodeficiency syndrome (AIDS) is essentially a sexually transmitted disease. As with other sexually transmitted diseases, the human immunodeficiency virus (HIV) which causes AIDS can also be transmitted through blood or blood products and from infected mother to baby.
Roughly only 5% of the AIDS cases in the world are estimated to have been caused by blood or blood products. However, the outcry and widespread public scare brought blood and blood product transfusion to the forefront of public perception. In the United States, several well-known personalities contracted AIDS, with the speculation from blood transmission. Whether valid or not, donations for blood or blood products fell to near zero nationwide.
As serendipity would have it, the concept of bloodless medicine arose in the 1970’s, when Dr. Denton Cooley, out of Texas Heart Institute in Houston, Texas performed cardiac procedures, a major operation, on patients that no other surgeon would touch Jehovah’s Witnesses.
In line with their doctrine, Jehovah’s Witnesses are not allowed to receive blood or blood products. This is in strict adherence to the organization’s interpretation in the Old and New Testament. Unfortunately, this is anathema to performing any major surgical procedure.
With these patients surviving a major operation without blood use and showing positive outcomes, a worldwide re-thinking on blood and/or blood products commenced.
Witnessing first-hand the remarkable improvement in patient outcomes, this author began preaching the advantages of blood management in the 1970’s when rotating out of the Military. It felt analogous to Saint Paul preaching in Damascus. Interest and receptive behavior were nonexistent. During the intervening fifty-four years, time, thereby longevity has validated the efficacy of blood management. There are too many downsides associated with blood products. Many adjustments and/or medications must be available to ameliorate any unintended consequence from an adverse event due to using blood or blood products.
About the Author
Thomas Muziani began his career in medicine in 1968. In 1970 he entered military service with the United States Army, attending Physician’s Assistant training in 1974. Mr. Muziani is the author of: “The Utah Protocol,” a syllabus for providing micro-doses of cardioplegia for extremely ill adults. The protocol has been utilized in over 800,000 patients with extremely positive outcomes. Mr. Muziani is the author of a continuing series entitled: “Standing on Tall Shoulders; The History of Cardiac Surgery.”
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