Tuesday, September 20, 2016

Why Blood is Bad Emergency Medicine



While more and more hospitals are jumping on the bloodless medicine bandwagon, emergency medicine seems to be going the other direction. Paramedics in some locations are beginning to carry blood in their ambulances and helicopters. 

Nearly every medical benefit – or supposed benefit – of transfused blood can now be achieved by some other treatment. So why is blood still being used?

I’m not a doctor, and I’m no medical expert. But I’ve written a lot about blood, and in the process I’ve learned a lot about blood medicine. The more I learn, the more appalled I am that doctors continue to consider blood transfusion an effective treatment – for anything. This brief column is intended to summarize what I’ve written previously.

You can read my other columns on the subject here: 

 As we discussed in the column Blood Medicine Part Two, it isn’t enough for the hemoglobin inside your red blood cells to absorb oxygen in the lungs. It also must let go of the oxygen when it gets to where it’s needed. Since oxygen is attracted to iron, releasing it is easier said than done. One ingredient that plays a key role in the release of oxygen from hemoglobin is a blood chemical called DPG. Lowering of DPG makes oxygen ‘stick’ to the hemoglobin – not good.

Blood pH must stay between 7.35 and 7.45 - always. A number outside that range will cause your body to stop all other functions until it has corrected its blood pH. Blood pH begins to fall in storage. Donated red blood cells are stored in a solution called ACD – acid-citrate-dextrose. ACD acidifies – lowers the pH – of the blood even more. The lower the pH, the ‘stickier’ the hemoglobin becomes. At 14 days, the pH of stored blood has fallen to 6.9. Since blood pH below 7.35 is considered an urgent problem, why does an emergency room doctor wants to give it to you?  

In one study of patients who received 3 units of blood in emergency operations, the conclusion was:

“In [an] acute situation, when the organism (that’s you) needs restoration of the oxygen releasing capacity within minutes, the resynthesis [of DPG in stored blood] is obviously insufficient.”

Put simply, a transfusion of stored blood is the last thing you want in an emergency.

Stored blood:
  • Carries antigens unique to the donor that can kill the recipient.
  • Carries Zika, malaria, hepatitis, HIV and a dozen other diseases.
  • Has a low pH, forcing the patient’s body to try to raise it back above 7.35.
  • Contains a high percentage of dead and dying cells that add to the workload of the patient’s spleen.
  • Contains inflexible red blood cells that cause clots.
  • Contains potassium at levels 4 times higher than are considered healthy
  • Contains ammonia at up to 10 times the upper limit of what is considered safe.
  • Contains free hemoglobin that steals oxygen from the patient and adds to the workload of the liver.
  • Is deficient in DPG, lowering the patient’s cellular oxygenation.
  • Is deficient in nitric oxide, lowering capillary dilation, causing reduced cellular oxygenation as well as clots.
  • Adds anti-coagulants to an already bleeding patient.
  • Raises blood pressure, straining and destroying fragile clots the body is trying to form at the wound site, increasing bleeding.
  • Suppresses the patient’s immune system for, at best, days; at worst, permanently.  
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 Bill K. Underwood is a freelance columnist and author of several books, including two novels - The Minotaur Medallion, and the best-selling Resurrection Day. Both are available in paperback here


1 comment:

  1. Have you mentioned Chagas disease yet Bill? That charming little Brazilian bug that bites tourists and defecates in the wound releasing the tiniest of viruses below microscopic range resulting in sickle cell anaemia. I knew a circuit overseer who carried this virus and was regularly threatened with amputation of the extremities if he would not submit to blood transfusion. He never did of course and it took Belfast general tropical diseased dept 20 years to indemnify the cause of his reoccurring anaemia.
    "What would have happened if I had been a blood Donner all these years? he asked a shocked professor of tropical deceases in front of a group of student doctors.

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