A blood transfusion in the thick of battle? Heretofore a transfusion at such a time has been a practical impossibility. While men are at their battle stations engaged in combat with the enemy, none could possibly be spared for a transfusion, no matter whose life might hang in the balance. But today, because of experiments being conducted at the Naval Medical Center, Washington, D. C., the hitherto impossible bids fair to become a practical procedure.
The work concerns itself not with the use of whole blood but of blood plasma for transfusion purposes. No donor is needed at the time of transfusion as the plasma does not come directly from the veins of an individual. It comes in bottles or other suitable containers and, when present experiments have shown the most satisfactory methods of preparing, handling, and use, plasma undoubtedly will form a part of the regular medical supplies to be stored on virtually every ship in the U. S. Navy.
The use of blood plasma in civilian life has been the subject of successful experimentation for a number of years, notably on the part of Dr. John Elliott of Salisbury, North Carolina, and two associates, Drs. G. F. Busby and W. L. Tatum. During the course of their work they have used it hundreds of times and have experienced but three adverse reactions, each of which was traced to a cause other than plasma. At present the substance is being employed successfully under war conditions in England, where Mr. Malcolm MacDonald, Minister of Health, recently reported on the excellent results that were being obtained.
Plasma is the liquid part of blood from which the red cells have been removed by centrifuging. This process causes them to settle at the bottom of the container, leaving an amber-colored upper layer. This liquid plasma is drawn off into sterile containers and is then ready for use.
In treating shock and hemorrhage, the red blood cells, it has been found, are not as important as is the liquid plasma. Shock, which is present to some degree in every serious injury and in many minor ones, is a condition in which, among others, structures of the blood vessels have become more permeable than normal and the liquid plasma has seeped out through the walls of arteries and veins. As the volume of blood decreases circulation naturally slows down and the heavy red cells begin to stagnate. Because of this, less and less oxygen is distributed through the body which adds to the degree of shock and a vicious circle is set up.
The primary consideration, therefore, under severe shock conditions, and obviously in cases of hemorrhage, is restoration of volume of circulation and of protein elements that have been lost. Plasma contains these elements and, as it is transfused, it restores volume of circulation and picks up the red cells which resume their normal functions of distributing oxygen and eliminating wastes.
Furthermore, in such cases, the time for transfusions is immediately after injury has occurred, not several hours later. Under many conditions, especially those that might be encountered in war time, it is impossible to give an immediate transfusion with whole blood. Even under ideal conditions a certain amount of time must elapse before a transfusion with whole blood may be given. The patient’s blood has to be typed, generally a donor has to be found, while other considerations may also enter the picture. But immediate transfusions can be given with plasma that has been collected in advance and effectively distributed and stored at strategic centers where it is readily available.
Research and experience have established the fact that whole blood can be kept only a few days. The cells begin to break down early, even when stored under most favorable conditions. Shaking has the same effect. Therefore, it cannot be transported any great distance. Unless it can be collected from day to day, used near at hand and while still fresh, transfusion with whole blood cannot be carried out with any degree of safety.
But every one of these limitations is overcome by the use of plasma. It has been kept without deterioration for lengthy periods. It has been transported great distances without damage and shaking does not affect it. It is ideal as a substitute for the now popular blood-banks.
Furthermore, plasma does not require typing. It may be pooled in large or small containers, thus simplifying storage and enabling distribution without waste. It may be administered anywhere, any time —aboard ship in the midst of an engagement, at a front line dressing station, or any other conceivable spot. All that is needed is the bottle of plasma and the necessary tubing and needles.
Experiments at the Naval Medical Center are currently being aided by the District of Columbia chapter of the American Red Cross which is enrolling volunteer blood donors. The first call for donors was issued in mid-September in response to a request from Rear Admiral Ross T. McIntyre, Surgeon General of the Navy, dated September 5. A total of 63 men and women responded to this initial appeal and additional donors have since been registered.
Once the present work has progressed to the point where the Medical Corps is prepared to proceed with the service on an enlarged scale, arrangements can then be made for the collection of plasma on a more extensive basis. What the detailed plans will call for, such as the establishment of collecting stations or methods of obtaining plasma, are matters for future determination, but it will be a comparatively simple matter to have donors enrolled by Red Cross chapters as these are located in virtually every community in the United States and thus are in a position to reach everyone, should that be found desirable.
The effectiveness of the Red Cross in the organization of volunteer blood donors is currently being demonstrated in the Greater New York and New Jersey areas. There, under the auspices of 23 local chapters, some 6,000 donors have been registered in a project to supply blood plasma to the British Red Cross. In this work the technical and scientific aspects are being handled by the Blood Transfusion Betterment Association, while registration of donors and shipments of plasma are undertaken by the Red Cross.
This project was originally announced August 12. So carefully had plans been laid and so immediate was the response that the first shipment of plasma, consisting of 10 liters, left LaGuardia Field via transatlantic clipper for London, August 15. Since that time weekly shipments, now approaching 100 liters, have gone forward regularly by steamer. This project, incidentally, also demonstrates what is being done with plasma from the standpoint of transportation and storage. Shipments have also been made by air from the Naval Medical Center to the Pacific coast and other points where the plasma was used to good effect and with what are termed “dramatic results.”
The Army Medical Corps currently is also experimenting with the use of blood plasma. In this project, too, the Red Cross is enrolling volunteer donors. Certain technical aspects of the studies, however, are being carried out, not by Army personnel, but by a committee of doctors named by the National Research Council of Washington, D. C. They are: Dr. Walter B. Cannon, Harvard University, Dr. Cyrus C. Sturgis, University of Michigan, Dr. Everett D. Plass, University of Iowa, Dr. Alfred Blalock, Vanderbilt University, and Dr. Max Strumia, Bryn Mawr Hospital, Philadelphia. Dr. Strumia is experimenting with the use of dried plasma as it might be adaptable to military practice, a phase of the subject which is not being overlooked in the experiments being conducted at the Naval Medical Center.
Perfection of detailed plans for the use and handling of blood plasma will enable starting the actual collection and storage of this substance for military purposes on short notice. Even should a wholesale need never occur, the experiments now being conducted by the Navy, as well as those being sponsored by the Army and others, will aid in the progress of blood transfusion in both civilian and military practice. As a result of this current interest in the subject, the operation undoubtedly will be developed into a simple procedure and thus be made available in every section of our country.
Although plasma has been found satisfactory in most cases where transfusions are necessary, whole blood will still have its uses. In the treatment of anemias, severe infections, and certain other forms of illness, the latter still is preferred and, when necessary, it undoubtedly will continue to be used as a follow-up after emergency plasma infusions. But it definitely is not required as an emergency first aid measure for the wounded, in medical opinion.
As a measure of national defense the use of blood plasma will prove of material importance. Not only will it enable many wounded and injured to recover, thereby lessening the need of having their places taken by untrained or partially trained men, but it will speed recovery. Thus, effective strength will be better maintained, less energy will be required in providing hospital care, and the fighting efficiency of the services will be increased.
Not to be overlooked in considering the use of plasma by our military and naval forces is its morale-building effect. The greater security thus offered the man in the service and the added comfort and peace of mind afforded to the home front are of inestimable value. Furthermore, millions of volunteer donors, who know that their gift of life’s precious fluid is preserving and sustaining countless thousands, will cherish anew the spirit of victory.