The East-West blood trade : How the German Democratic Republic obtained foreign currency with blood products (1983-1990).

Using the East-West blood trade of the German Democratic Republic (GDR) in the 1980s as an example, this study aims to show what kind of problems arise when trade agreements are made with authoritarian regimes, where transparency is lacking and the general public is not informed about the trading conditions. Files from the Ministry of Health and the Foreign Trade Ministry show the extent, aims, and scope of the blood exports to the West. Within the East-West trade, blood was regarded solely as a commercial good; ethical concerns played no part. The blood trade was the most important income source of unscheduled foreign currency for the GDR health sector. People were asked to donate for the wellbeing of society and without receiving remuneration. They were unaware that their blood was an object of commercial trade. Most of the revenue was put into secret accounts of the GDR Foreign Trade Ministry or went to Western intermediaries. The regulations for blood deliveries often challenged the blood donation institutes; they lacked donors, modern techniques/equipment, and personal. Buyers in the West repeatedly complained about the quality of the blood products. The Western intermediaries sold the goods to bulk-buyers, predominantly in German-speaking countries.

Unfolding epidemiological stories: how the WHO made frozen blood into a flexible resource for the future.

In the decades after World War II, the World Health Organization (WHO) played an important role in managing the process of stabilizing collections of variable blood samples as a fundamentally unstable, protean, and unfolding biomedical resource. In this system, known and as yet unknown constituents of blood were positioned as relevant to the work of multiple constituencies including human population geneticists, physical anthropologists, and immunologists. To facilitate serving these and other constituencies, it was crucial to standardize practices of collecting and preserving samples of blood from globally distributed human populations. The WHO achieved this by linking its administrative infrastructure-comprised of expert advisory groups and technical reports-to key laboratories, which served as sites for demonstrating and also for disseminating standards for working with variable blood samples. The practices that were articulated in making blood samples into a flexible resource contributes to emerging histories of global health that highlight the centrality of new institutions, like the WHO, new forms of expertise, like population genetics and serological epidemiology, and new kinds of research materials, like frozen blood.

Blood platelet kinetics and platelet transfusion.

The discovery of citrate anticoagulant in the 1920s and the development of plastic packs for blood collection in the 1960s laid the groundwork for platelet transfusion therapy on a scale not previously possible. A major limitation, however, was the finding that platelet concentrates prepared from blood anticoagulated with citrate were unsuitable for transfusion because of platelet clumping. We found that this could be prevented by simply reducing the pH of platelet-rich plasma to about 6.5 prior to centrifugation. We used this approach to characterize platelet kinetics and sites of platelet sequestration in normal and pathologic states and to define the influence of variables such as anticoagulant and ABO incompatibility on post-transfusion platelet recovery. The "acidification" approach enabled much wider use of platelet transfusion therapy until alternative means of producing concentrates suitable for transfusion became available.

Impact of blood collection devices on clinical chemistry assays.

Blood collection devices interact with blood to alter blood composition, serum, or plasma fractions and in some cases adversely affect laboratory tests. Vascular access devices may release coating substances and exert shear forces that lyse cells. Blood-dissolving tube additives can affect blood constituent stability and analytical systems. Blood tube stoppers, stopper lubricants, tube walls, surfactants, clot activators, and separator gels may add materials, adsorb blood components, or interact with protein and cellular components. Thus, collection devices can be a major source of preanalytical error in laboratory testing. Device manufacturers, laboratory test vendors, and clinical laboratory personnel must understand these interactions as potential sources of error during preanalytical laboratory testing. Although the effects of endogenous blood substances have received attention, the effects of exogenous substances on assay results have not been well described. This review will identify sources of exogenous substances in blood specimens and propose methods to minimize their impact on clinical chemistry assays.