Blood Transfusion

Author Question: Blood Types and Blood Transfusions

/ Jordyn Redwood / 2 Comments

Ryana Asks:

I want to do a story set in WWII and one of my climaxes is when a Jewish soldier gives blood to save a German soldier’s life (or vice versa). My question is this: do different races have different blood types? Like, do Jews have a blood type no one else has? I don’t want to do something medically incorrect just because I think my story is good.

Jordyn Says:

There are eight different blood types and all ethnicities/races can have one of these blood types though some are more prevalent in a race than others. Here is an interesting link where the Oklahoma Blood Institute looked at what blood types certain races were and their break down.

I think the harder part of your question is would these two soldiers, by chance, have the same blood type where it wouldn’t cause a life threatening reaction in the soldier receiving blood. I was able to Google this question and found this link. As you can see, the best odds are if both soldiers are O-positive and yet that random chance that both are the same blood type is only 38%. The next highest is if both are A-positive at 34%. The other blood types fall precipitously after that. Of course, if the soldier giving the blood is O-negative (this is the universal donor) then there should be no reaction regardless of what blood type the receiving soldier is. On the reverse side, the universal recipient (someone who can get anyone’s blood) is AB-positive.

It would actually increase conflict in your story if the soldier receiving blood DID have a transfusion reaction. This type of reaction would be called a hemolytic transfusion reaction. This article reviews some of the varied responses a patient can have. Of course, you’d have to consider the time frame of your piece and what treatment would have been available then.

Hope this helps and good luck with the story!

When Does a Person Require Blood Transfusion?

/ Jordyn Redwood / 2 Comments

Sometimes, it’s hard to know when writing a scene when to pull the big guns out. If you have a character that is bleeding a lot (by whatever mechanism) when should you think about giving them blood? Or, better yet, when will the lack of blood begin to hamper their ability to function.

Fairly consistent among resources, hemorrhagic shock (shock related specifically to blood loss) is a life-threatening condition that results when you lose more than 20% or 1/5th of your blood supply. Patients will feel lightheaded, dizzy. Their respiratory rate and heart rate will be elevated. Their blood pressure might be low. They’ll look pale, pasty. Their skin might feel cool, clammy, dough-like.

But exactly how much blood does that translate to? I actually found this nifty little calculator that will give you a person’s estimated blood volume based on their age, sex, and weight. For instance, a man weighing 100 kg has an estimated blood volume of 7,500 ml. So losing 20% of his blood volume would be 1,500 ml of blood or approximately 3 pints of blood. A pint of whole blood (what you would donate) is approx 500 ml. A woman of the same weight has only 6,500 ml of circulating blood. An infant weighing 10 kg has only 800 ml of blood. You can see how that 20% translates much differently depending on the characters age, sex and weight.

History of Blood Transfusion

/ Jordyn Redwood / Leave a comment

For historical authors, it’s important to know when a medical advancement takes place for novels that include these medical details. While researching a medical question for an author regarding blood transfusion I came across a very good timeline concerning this medical advancement. You can find that article here.  Additional resource found here.

1628: Dr. William Harvey discovers blood circulation.

1655: Dr. Richard Lower performs successful animal to animal blood transfusion using dogs.

1818: Dr. James Blundell performs first person to person blood transfusion. Blundell is a gynecologist and uses blood transfusions to treat postpartum hemorrhage.

1840: Successful blood transfusion of patient with hemophilia.

1901-1902: Karl Landsteiner discovers blood types. This is an important advancement because giving the patient the wrong blood type can well . . . kill them.

1914-1918: Dr. O.H. Robinson finds effective anticoagulant that aids in long-term blood storage. Adolf Hustin is also credited with discovering an anticoagulant as well.

1920’s: Percy Oliver develops donor system for British Red Cross.

1932: Leningrad Hospital houses first blood bank.

1939-1940: Rh Blood group is discovered which is determined to be the cause of most blood transfusion reactions.

1941: Red Cross U.S.A. is started.

1950: Use of plastic bags makes collecting and storing blood easier. Before this they used glass bottles. This I cannot imagine.

1972: Apheresis is discovered which can remove one component of blood and return the rest to the donor.

1983: Stanford Blood Center begins screening donated blood for AIDS.

1985: HIV screening licensed and implemented.

1990: Hepatitis C Screening initiated.

It’s amazing to look back on just how much was accomplished in blood transfusion, blood banking, and ensuring a safe blood supply in the 20th century.

Author Question: Transfusing Blood Post EMP Blast

/ Jordyn Redwood / 3 Comments

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!