Alyssa Asks:

An EMP took out all electricity 2 years ago— meaning no electricity, refrigeration, or other modern medical machines. The city has been isolated since then. Ruling gangs have raided the hospitals, but our gang of survivors managed to snag a number of essential hospital supplies including a field transfusion kit.

Patient is 6 years old. She has lost a large amount of blood from a scalp wound. They don’t know how much blood since it’s dark and they weren’t there when it happened, but she’s sheet-white, cold and clammy skin, blue lips and fingernails, shallow breath, quick pulse but low blood pressure. No access to Saline. Looks like blood is the only option.

Our nurse, she tells the others about the risks, even though the donor and recipient have the same blood type. Antibodies causing a reaction, infection, too much blood, etc. But it’s a dire situation.

Could they run an IV from the donor into a blood bag using gravity? Bags suspended in cold water to keep it cold and inject anticoagulant into the bag port once the blood starts filling it?

They’d only use one unit. Once they fill the bag, they’d use another blood tube to run it into an IV attached to our young recipient. Again, they’d use gravity, but the girl would be on a table and the blood bag suspended above her, maybe hanging on a hanger on a back of the door. Would this work?

Jordyn Says:

Thanks, Alyssa, for sending me your question. It is fairly complicated so I’m going to give a little background.

First of all, kids do not get the same amount of blood as an adult. We transfuse kids based on their weight. Your average 6 y/o weighs about 22 kg. Kids get 10ml/kg for their transfusion volume so this child needs approximately 220 ml of blood. We also don’t routinely transfuse whole blood. What we give is packed red blood cells— exactly as the name sounds. One unit of whole blood is split up into many different parts (packed red blood cells, platelets, and plasma).

What you’re talking about is giving whole blood which will lessen the amount of packed red blood cells your patient is getting. I’d stick with transfusing about 200 ml of whole blood as a marker to start. One unit of blood can hold up to 525 ml so your patient would need roughly half of one bag. It will be hard for your character to measure that in this situation so the nurse will have to go off improvement of her patient’s vital signs. These would include improved color, warmer skin, decreased heart rate and increasing blood pressure.

Bags that collect blood already have a component inside to keep the blood from clotting so I don’t think I’d even worry about an anticoagulant. I don’t even know that you’d really need to worry about cooling the blood. Collection takes somewhere between 10-30 minutes depending on the size of the vein accessed. Usually for blood collection the antecubital vein is used (the one at the crook of your elbow).

While the blood is being collected from the donor (yes, by gravity— the bag lower than the donor), the nurse can start an IV in her patient. You would need a set of IV tubing to puncture the blood bag, prime the tubing with the blood, and then give it to your patient. No air in the line, please. Hanging the unit by any means possible is fine as long as it is higher than the recipient.

Usually, blood is given with a filter in the line so if they had stolen a blood transfusion field kit then hopefully this would be part of it.

Your other option is to do old style person to person transfusion of which you can see a photo here and not mess with collecting the blood at all.

Hope this helps and good luck with your story!