From battlefront to homefront: creation of a civilian walking blood bank.

Hemorrhagic shock remains the leading cause of preventable death on the battlefield, despite major advances in trauma care. Early initiation of balanced resuscitation has been shown to decrease mortality in the hemorrhaging patient. To address transfusion limitations in austere environments or in the event of multiple casualties, walking blood banks have been used in the combat setting with great success. Leveraging the success of the region-wide whole blood program in San Antonio, Texas, we report a novel plan that represents a model response to mass casualty incidents.

Keeping Dr. Charles Richard Drew's legacy alive.

The Charles R. Drew University of Medicine and Science (CDU) recently celebrated its fiftieth anniversary. The university was established to honor Dr. Charles Richard Drew, a pioneer in blood banking. As a tribute to the legacy of CDU and Dr. Drew, the CDU Health Sciences Library examined how CDU is keeping Dr. Drew's legacy alive.

Modernizing the flow of blood: Biomedical technicians, working knowledge and the transformation of Swedish blood centre practices.

The early 1980s saw a 'paradigm change' in how donated blood was handled and used by blood centres, hospitals and pharmaceutical companies. In Sweden, a five-year state-financed R&D programme initiated a swift modernization process, an alleged 'revolution' of existing blood centre practices. In this article, we use interviews and archival material to analyse the role of female biomedical technicians in this rapid technical and organizational change. In focus is their working knowledge, or savoir-faire, of blood, instruments and techniques. We give a detailed analysis of technicians' embrained and embodied skills to create safety in blood and its representations, handle contingencies and invent new procedures and techniques. These transformations are analysed as sociomaterial entanglements, where the doing and undoing of gender, sociomaterial practices, hierarchies of authority and expertise, and emotions are intertwined.

Breaking the taboo: a history of monetary financing in Canada, 1930-1975.

Monetary financing - the funding of state expenditure via the creation of new money rather than through taxation or borrowing - has become a taboo policy instrument in advanced economies. It is generally associated with dangerously high inflation and/or war. Relatedly, a key institutional feature of modern independent central banks is that they are not obligated to support government expenditure via money creation. Since the financial crisis of 2007-2008, however, unorthodox monetary policies, in particular quantitative easing, coupled with stagnant growth and high levels of public and private debt have led to questions over the monetary financing taboo. Debates on the topic have so far been mainly theoretical with little attention to the social and political dynamics of historical instances of monetary financing. This paper analyses one of the most significant twentieth-century cases: Canada from the period after the Great Depression up until the monetarist revolution of the 1970s. The period was a successful one for the Canadian economy, with high growth and employment and manageable inflation. It offers some interesting insights into the relationship between states and central banks and present-day discussions around the governance of money creation.

Sibling cord blood donor program for hematopoietic cell transplantation: the 20-year experience in the Rome Cord Blood Bank.

Umbilical cord blood (UCB) represents a source of hematopoietic stem cells for patients lacking a suitably matched and readily available related or unrelated stem cell donor. As UCB transplantation from compatible sibling provides good results in children therefore directed sibling UCB collection and banking is indicated in family who already have a child with a disease potentially treatable with an allogeneic hematopoietic stem cell transplantation. Particularly, related UCB collection is recommended when the patients urgently need a transplantation. To provide access to all patients in need, we developed a "Sibling cord blood donor program for hematopoietic cell transplantation". Here we report results of this project started 20years ago. To date, in this study a total of 194 families were enrolled, a total of 204 UCB samples were successfully collected and 15 pediatric patients have been transplanted. Recently, some authors have suggested novel role for UCB other than in the transplantation setting. Therefore, future studies in the immunotherapy and regenerative medicine areas could expand indication for sibling directed UCB collection.

Blood, Soy Milk, and Vitality: The Wartime Origins of Blood Banking in China, 1943-45.

This article examines the multiple meanings of blood transfusion and banking in modern China through the history of the first Chinese blood bank, established by the Overseas Chinese in 1943 to solicit blood for the war effort. Through investigating the attitudes of Chinese soldiers and civilians toward the blood bank, this article argues for the multiplicity of motivations underpinning society's attitudes toward blood banking and donation. Cultural notions of blood were an important but not the sole factor in their consideration. Ideas of nationalism and altruism played a role too. What eventually turned out to be most effective for most donors was the promise of eggs and soy milk for blood. Its economic value in the context of wartime scarcity was enough for many to abandon opposition to blood banking. By drawing attention to socioeconomic concerns in biomedical practices, this article provides an alternative examination of blood banking in modern societies.

Going for gold: blood planning for the London 2012 Olympic Games.

The Olympics is one of the largest sporting events in the world. Major events may be complicated by disruption of normal activity and major incidents. Health care and transfusion planners should be prepared for both. Previously, transfusion contingency planning has focused on seasonal blood shortages and pandemic influenzas. This article is the first published account of transfusion contingency planning for a major event. We describe the issues encountered and the lessons identified during transfusion planning for the London 2012 Olympics. Planning was started 18 months in advance and was led by a project team reporting to the Executive. Planning was based on three periods of Gamestime. The requirements were planned with key stakeholders using normal processes enhanced by service developments. Demand planning was based on literature review together with computer modelling. The aim was blood-stock sufficiency complimented by a high readiness donor panel to minimise waste. Plans were widely communicated and table-top exercised. Full transfusion services were maintained during both Games with all demands met. The new service improvements and high readiness donors worked well. Emergency command and control have been upgraded. Red cell concentrate (RCC) stock aged but wastage was not significantly increased. The key to success was: early planning, stakeholder engagement, service developments, integration of transfusion service planning within the wider health care community and conduct within an assurance framework.

Military medical advances resulting from the conflict in Korea, Part I: Systems advances that enhanced patient survival.

The Korean War started several years after the World War II had ended and no recognition of the threat or preparation was made for this possibility. The military and its medical service had been downsized after World War II and had to quickly ramp up to meet the surprise attack. The war provided the laboratory for trials and experimentation with the new technological developments of the era. The Korean conflict led to numerous advances in medical systems and patient care. The Mobile Army Surgical Hospital came of age, and was instrumental in saving many lives. Helicopters saw their first regular use as flying ambulances to take the injured to definitive care in a timely fashion. The national blood banking program was rapidly geared up and new techniques such as plastic bags for collection and delivery resulted. Body armor was developed that would allow mobility while offering protection and was widely used for the first time. Each of these systems improvements saved the lives of soldiers in combat and were soon to be used in the civilian sector to save and improve lives around the world.

Milestones in umbilical cord blood transplantation.

Much has been learned about umbilical cord blood (UCB) since the first human cord blood transplant was performed back in 1988. Cord blood banks have been established worldwide for the collection, cryopreservation and distribution of UCB for allogeneic haematopoietic stem cell transplantation. UCB has now become one of the most commonly used sources of haematopoietic stem cells for allogeneic transplantation. Today, a global network of cord blood banks and transplant centres has been established with a large common inventory, allowing for more than 20000 transplants worldwide in children and adults with severe haematological diseases. Several studies have been published on UCB transplant, assessing risk factors such as cell dose and human leucocyte antigen mismatch. New strategies are ongoing to facilitate engraftment and reduce transplant-related mortality and include the use of reduced-intensity conditioning regimen, intra-bone injection of cord blood cells, double cord blood transplants or ex vivo expansion of cord blood cells. The absence of ethical concern and the unlimited supply of cells explain the increasing interest of using UCB for developing regenerative medicine.

Evolution in a centralized transfusion service.

The metropolitan Seattle area has utilized a centralized transfusion service model throughout the modern era of blood banking. This approach has used four laboratories to serve over 20 hospitals and clinics, providing greater capabilities for all at a lower consumption of resources than if each depended on its own laboratory and staff for these functions. In addition, this centralized model has facilitated wider use of the medical capabilities of the blood center's physicians, and a county-wide network of transfusion safety officers is now being developed to increase the impact of the blood center's transfusion expertise at the patient's bedside. Medical expectations and traffic have led the blood center to evolve the centralized model to include on-site laboratories at facilities with complex transfusion requirements (e.g., a children's hospital) and to implement in all the others a system of remote allocation. This new capability places a refrigerator stocked with uncrossmatched units in the hospital but retains control over the dispensing of these through the blood center's computer system; the correct unit can be electronically cross-matched and released on demand, obviating the need for transportation to the hospital and thus speeding transfusion. This centralized transfusion model has withstood the test of time and continues to evolve to meet new situations and ensure optimal patient care.

Storage of whole blood for up to 24 hours at ambient temperature before component preparation: implementation in the Netherlands.

The aim of this article is to reflect on the historical background on what urged the authors in the 1980s to investigate the prolonged storage of whole blood at ambient temperature before component preparation, the routine implementation of the method in the Netherlands, and the effect on logistics and plasma procurement.

The making of a risk object: AIDS, gay citizenship and the meaning of blood donation in Sweden in the early 1980s.

In the early 1980s acquired immune deficiency syndrome (AIDS) presented a danger to the blood supply, the extent of which was difficult to ascertain before a reliable test became available in 1985. In a situation of uncertainty, the major Swedish gay organisation in early 1983 recommended voluntary exclusion from blood donation by their members, while internationally gay organisations protested and Swedish medical authorities hesitated about the appropriate action to take. At stake were definitions of gay citizenship, risk and the gift of blood. The article uses three sociological approaches to understand the controversies around blood from men-who-have-sex-with-men as a risk to public health. An institutional approach is used to situate the symbolic meaning of blood donation within the specific Swedish blood collection regime, and thus the possible stigma of exclusion from donation practices. The article then details the evolution of different risk objects, based on different actors' situated knowledge of the danger, and discusses the different framing conditions influencing decision-making by the various actors involved. The analysis uses extensive archival and secondary material to trace decisions taken in the gay movement, medical authorities and blood centres, and to assess their outcome on the spread of AIDS via the blood supply.

The Story of Blood for Shock Resuscitation: How the Pendulum Swings.

Whole blood transfusion (WBT) began in 1667 as a treatment for mental illness, with predictably poor results. Its therapeutic utility and widespread use were initially limited by deficiencies in transfusion science and antisepsis. James Blundell, a British obstetrician, was recognized for the first allotransfusion in 1825. However, WBT did not become safe and therapeutic until the early 20th century, with the advent of reliable equipment, sterilization, and blood typing. The discovery of citrate preservation in World War I allowed a separation of donor from recipient and introduced the practice of blood banking. During World War II, Elliott and Strumia were the first to separate whole blood into blood component therapy (BCT), producing dried plasma as a resuscitative product for "traumatic shock." During the 1970s, infectious disease, blood fractionation, and financial opportunities further drove the change from WBT to BCT, with few supporting data. Following a period of high-volume crystalloid and BCT resuscitation well into the early 2000s, measures to avoid the resulting iatrogenic resuscitation injury were developed under the concept of damage control resuscitation. Modern transfusion strategies for hemorrhagic shock target balanced BCT to reapproximate whole blood. Contemporary research has expanded the role of WBT to therapy for the acute coagulopathy of trauma and the damaged endothelium. Many US trauma centers are now using WBT as a front-line treatment in tandem with BCT for patients suffering hemorrhagic shock. Looking ahead, it is likely that WBT will once again be the resuscitative fluid of choice for patients in hemorrhagic shock.

Mark M. Ravitch: A Staple in Surgical History and Innovation.

Mark M. Ravitch is a surgeon worth acknowledging. He is credited for revolutionizing pediatric surgery as a subspecialty, mastering chest wall deformities and introducing the surgical stapler to the United States, to name a few. Above all, he was a notable leader, teacher, and author. This historical vingette is a brief snapshot of his biography and various achievements.

Cord blood banking: a historical perspective.

Umbilical cord blood (UCB) contains stem and progenitor cells capable of restoring haematopoietic and immunological function in vivo. UCB is currently used as an alternative source of haematopoietic stem cells for transplantation in patients suffering from haematological malignancies, bone marrow failures and inherited metabolic disorders. In order to facilitate transplantation, large repositories of frozen cord blood units (CBUs) from altruistic donations have been established in many parts of the world and to date there are more than 300,000 units stored worldwide. These products have been banked under stringent quality conditions, in order to ensure their safety and efficacy. The development and evolution of the policies and procedures currently in use in cord blood banking have been largely influenced by the clinical results of cord blood transplantation. This review aims to provide a historical overview of the various developments in the field of cord blood banking from its inception, highlighting the relevant aspects in their collection, banking and release that are known to influence the clinical outcome of these transplants.