Implementation of the Program

Blood Banks Established

Book excerpt

By: Douglas B. McKendrick

Date: 1964

Source: Douglas B. McKendrick. Blood Program in World War II. Washington, D.C.: U.S. Government Printing Office, 1964.

About the Author: Brigadier General Douglas B. Kendrick was the officer responsible for the Army blood program during World War II and much of the Korean War. The book was published by the Office of Medical History, which is part of the U.S. Surgeon General's Office. The mission of the Office of Medical History is to support the men and women of the U.S. Army Medical Department through publications that recognize their contribution in conflicts such as World War II.

INTRODUCTION

In 1900, the Austrian immunologist Karl Landsteiner (1868–1943) showed that blood serum from a donor often caused the red blood cells of the recipients to clump together, indicating some fundamental incompatibility. He went on to discover the A, B, O blood group system, which laid the foundations for the science of blood banking and transfusions. Then, at the start of World War I, in 1914, it was shown that the addition of citrate, along with refrigeration, helped preserve blood donations for transfusion. Although there are no figures for the number of transfusions carried out in World War I, there is evidence that it was widely used and was regarded as the most important medical development of the conflict.

Between the two World Wars (1918–1939), major strides in the large scale banking and transfusion of blood were made. For instance, in 1935, a group of doctors at the Mayo Clinic in Rochester, Minnesota, became the first to build on their experience of blood transfusion by beginning to store citrated blood. This "banked" blood was utilized for transfusion in a hospital setting.

Then, in August 1936, Federico Duran-Jorda established the Barcelona Blood Transfusion Service. He and his team collected blood, tested it, and pooled it by blood group before storing it under refrigeration. The blood could then be transported in refrigerated vehicles to the front line in the Spanish Civil War. This was the kind of experience that set the scene for the appeals for blood, described in the excerpt, to help wounded soldiers in World War II.

PRIMARY SOURCE

The Surgeons General of the Army and the Navy sent identical letters to Mr. Davis on 7 January 1941, requesting the cooperation of the American Red Cross in the collection of blood for plasma, as follows:

The national emergency requires that every necessary step be taken as soon as possible to provide the best medical service for the expanded armed forces. Even though the need for proper blood substitutes may not be immediate, there seems every reason to take steps now which shall provide in any contingency for an adequate supply of these substances for use in individuals suffering from hemorrhage, shock, and burns.

To this end, in order to assure this adequate supply of the blood substitutes for the use of the United States Army, I am asking the American Red Cross and the Division of Medical Sciences, National Research Council, to organize a cooperative undertaking which shall provide the armed services with human blood plasma. In this cooperative effort, I request the American Red Cross to secure voluntary donors in a number of the larger cities of this country, to provide the necessary equipment, to transport the drawn blood rapidly to a processing center, to arrange for separating the plasma and for storing the resulting product in refrigerated rooms.

I am also requesting the Division of Medical Sciences, National Research Council, to assume general supervision of the professional services involved in this collection and storage of blood plasma, and to provide competent professional personnel, both for a national supervising group and for the local collecting agencies. I am also urging that the National Research Council continue to encourage investigation of the various methods of preparation of blood substitutes, preferably in dried form.

While it is impossible to estimate the requirements of the armed forces at the present time, because of the uncertainties of the international situation, I feel strongly that a large quantity, a minimum of 10,000 pints, of blood plasma should be placed and maintained in refrigerated storage. This feeling is based upon the fact that not only will the plasma be of greatest service if a military emergency arises, but also of ultimate use in any national catastrophe.

I am also writing to the National Research Council making this identical request, and am expressing the hope that the cooperative undertaking may receive approval, with prompt organization of the whole enterprise.

On 9 January 1941, Mr. Davis replied as follows:

The American Red Cross will be glad, as requested in your letter of January 7th, to cooperate with the Division of Medical Sciences of the National Research Council and the Army and the Navy in providing the armed services with human blood plasma.

Representatives of the Red Cross will confer with representatives of the National Research Council and the Army and the Navy immediately in order to formulate the necessary plans for getting the project underway.

On 7 January 1941, Maj. Gen. James C. Magee and Vice Adm. Ross T. McIntire, MC, USN, wrote Dr. Lewis H. Weed, Chairman, Division of Medical Sciences, NRC, requesting the cooperation of his agency in this project.

On 9 January, Dr. Weed replied as follows:

I wish to acknowledge receipt of your letter of yesterday requesting that the American Red Cross and the Division of Medical Sciences, National Research Council, cooperate in an undertaking which will lead to the procurement of large quantities of human blood plasma.

I can assure you at once that the Division of Medical Sciences will do everything possible to make this cooperation effective. In fact, I am sure that I speak for the members of the Division in telling you that every effort will be made to accelerate the whole mechanism of obtaining and processing the necessary blood.

The Division of Medical Sciences has already taken the initial steps leading to the formation of an operating subcommittee under the general Committee on Transfusions and will probably select Dr. C. P. Rhoads of Memorial Hospital as the chairman of this committee. No time will be lost in undertaking the necessary organization so that a supply of human plasma may be in storage for the use of the armed forces.

SIGNIFICANCE

In 1941, when the United States first entered the war, it was felt that blood plasma, rather than whole blood, would be the most appropriate treatment for soldiers suffering from shock caused by blood loss. However, it became apparent that British physicians were saving more lives through the use of whole blood transfusions. By 1944, whole blood was being transported by air from the U.S. to help soldiers in European and the Pacific theaters of the war.

Thus, in response to the demands of the world war, the U.S. military had built the first national blood donation program. In all, more than 13 million pints of whole blood were drawn by the American Red Cross during World War II for direct use or for the preparation of plasma. Only some of this was used by the military, and the rest was diverted to civilian purposes. After the war, the national blood program declined and it was rebuilt as a localized civilian program.

The U.S. entered the Korean War in 1950 without a national blood program in place and no blood was shipped to Korea during the first seventy days of the conflict. A program was assembled in due course, drawing on the experience of World War II, and 400,000 units were used in the next three years. A certain amount of blood was wasted, which led to the development of plastic blood bags for better storage.

Beginning in 1965, the Vietnam War required a military blood program for almost ten years, and many useful lessons were learned from the experience. For instance, studies sponsored by the military enabled whole blood to be stored for four or five weeks, depending on the citrate formula used. Packed red blood cells and fresh-frozen plasma also were used for the first time. Frozen red blood cells also were used briefly in Vietnam and were re-introduced in the Gulf War of 1990–1991. Blood also has been used in more recent conflicts such as those in Bosnia, Kosovo, and Iraq.

Experience shows that blood is used less efficiently in a war situation than it is for civilian purposes. For instance, in the Bosnian War, 5,600 units of red blood cells were supplied, but only 79 were used. The remainder was not all wasted—some was given to Bosnian hospitals in desperate need and the U.S. civilian supply did not suffer. In the Gulf War, there were fewer casualties than had been anticipated, so much of the blood requisitioned was never used. War is, inevitably, unpredictable. Over the last century, medical experience in military conflicts has led to the establishment of a national blood banking system that not only covers the uncertainties of war, but also provides for the needs of the civilian population.

FURTHER RESOURCES

Web sites

International Trauma, Anesthesia and Critical Care Society. "Blood Use in War and Disaster: The U.S. Experience." http://www.itaccs.com/traumacare/archive/05_01_Winter_2005/blooduse.pdf#search='Blood%20Program%20in%20World%20War%20II'〉 (accessed November 23, 2005).

Public Broadcasting Service (PBS). "Red Gold: The Epic History of Blood. Blood History, 1920–1949, The Impact of War." 〈http://www.pbs.org/wnet/redgold/history/timeline4.html〉 (accessed November 23, 2005).