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Ehmke 1 Anyone who is in good health, is at least 17 years old, and weighs at least 110 pounds may donate

blood every 56 days (americasblood.org). This donated blood will then be used on people in need of blood transfusions. However, the only way to provide donated blood for patients, is to have blood donors. The donors are the only source of blood, for it cannot be made or manufactured (10). Approximately five million Americans need a blood transfusion every year (nhlbi.nih.gov). Without the procedure, the nation's population would be a small fraction of what it is today. Although there are many risks, blood transfusions save lives. The first attempted blood transfusion was experimented on Pope Innocent VIII as he descended into a coma in 1492. Three boy's blood were used for the Pope. The blood was infused into his mouth. His doctor believed this was the right way to infuse blood. The boys were ten years old, and had been promised a ducat each. However, not only did the Pope die, but so did the three children (news-medical.net). This unsuccessful attempt led to the beginning of many findings pertaining to blood transfusions. The discoveries of major components that led to successful blood transfusions originate as far back as the 1600s. In 1628, before the blood components were discovered, William Harvey discovered the circulation of blood. After this discovery, the first fully documented blood transfusion was attempted. In 1665, Richard Lower performed the first successful blood transfusion in England. The procedure was performed on a dog by using another dog's blood. However, attempts on humans still had the result of death (6). Years later, [t]he first fully documented human blood transfusion was administered by Dr. Jean-Baptiste Denys, eminent physician to King Louis XIV of France, on June 15, 1667. He transfused the blood of a sheep into a 15-year old boy, who survived the transfusion. Denys performed another transfusion [on] a labourer, who also survived. Both instances were likely due

Ehmke 2 to the small amount of blood that was actually transfused. This allowed them to withstand the allergic reaction. Denys' third patient to undergo a blood transfusion was [a] Swedish [man named] Baron Bonde. He received two transfusions. After the second transfusion[,] Bonde died. In the winter of 1667, Denys performed several transfusions on Antoine Mauroy with calf's blood, who [eventually] died. Much controversy surrounded his death. Mauroy's wife asserted Denys was responsible for her husband's death. Mauroy's wife [also] was accused of causing his death[, t]hough it was later determined that Mauroy actually died from arsenic poisoning[, meaning Denys and Mauroys wife were innocent. Afterwards,] Denys' experiments with animal blood provoked a heated controversy in France. Finally, in 1670 the procedure was banned. In time, the British Parliament and even the pope followed suit. Blood transfusions fell into obscurity for the next 150 years (6). In 1818, the first successful blood transfusion using human blood was accomplished. Dr. James Blundell had a patient who had postpartum hemorrhage, in order to treat the patient, Dr. Blundell had to transfuse the patients blood. Blundell used the patient's husband as the blood donor. During the years 1825 and 1830, Dr. Blundell performed 10 transfusions, five of which were beneficial, and published his results. He also invented many instruments for the transfusion of blood (6). In 1901, Karl Landsteiner, an Austrian scientist, discovered the three human blood groups (redcrossblood.org)(fi.edu). This discovery made blood transfusions a much safer procedure (6). Landsteiner classified blood according to the differences of blood cells analyzed under a microscope. He found that there were two very different chemical molecules on the red blood cells. Therefore, he labeled one A and the other B. He then found that there was a mixture of both molecules and named it AB. If the blood had neither A or B, then he

Ehmke 3 labeled it O. These labels later became known as blood types. Landsteiner then discovered that if two different blood types mixed together, the blood cells would be incompatible and would start to clump together in the blood vessels, causing a high risk of death. A person with type A blood can donate blood to a person with type A or type AB. A person with type B blood can donate blood to a person with type B or type AB. A person with type AB blood can donate blood to a person with type AB only. A person with type O blood can donate to anyone. A person with type A blood can receive blood from a person with type A or type O. A person with type B blood can receive blood from a person with type B or type O. A person with type AB blood can receive blood from anyone. A person with type O blood can receive blood from a person with type O (10). Due to the high risk of death, it is very important that blood types are matched before blood transfusions are done. In emergencies, type O blood can be given to anyone, for it is the universal blood (10). This is so because people who have type O blood are known as the universal donors, which means that the donated blood can be given to all. There is, however, still a risk (3). In 1939-1940, Karl Landsteiner, Alexander Wiener, Philip Levine and R.E. Stetson discovered the Rh blood factor (5). The Rh factor was discovered when these scientists noticed that Rhesus monkeys shared certain similarities with the human species. The scientists began to study these animals and eventually discovered a certain blood protein that the Rhesus monkeys had. This blood protein was then discovered to be in some human blood. Other human blood seemed to be lacking this protein. This protein is now known as the Rhesus factor, or Rh for short. If any blood has this protein, then it is known to be Rh positive. If the blood lacks this protein, then it is known to be Rh negative. It is important to know the type of Rh factor in pregnant mothers. Sometimes a baby will receive a different Rh factor from the father than the

Ehmke 4 mother, which would put the baby's life in danger. The mother's blood type would attack the baby's and would result in death of the baby. However, an exchange transfusion can be done so that the baby's blood matches the mother's (3). Thanks to the scientists from the past, the blood components and information our society uses today are reliable; such as the most important component of a blood transfusions, blood. Blood is [a] fluid that circulates in the heart, arteries, capillaries, and veins of a vertebrate animal (merriam-webster.com). Some of the primary purposes of blood are to deliver essential elements and remove harmful waste. Blood transports oxygen from the lungs to the body tissue and carbon dioxide from the body tissue (3). This fluid also produces many vital tasks, such as fighting infections and healing wounds (10). Vitamins and minerals help keep the blood healthy (3). Throughout blood, there are four major components: red blood cells, white blood cells, plasma, and platelets (10). One drop of blood contains millions of red blood cells. These cells eventually die, but bones are always producing new blood cells. The average cycle of a red blood cell is 120 days (3). This disc-shaped cell contains hemoglobin, which is what makes blood red and also allows the cells to deliver oxygen to the entire body, then pick up carbon dioxide and remove it from tissues (10). Hemoglobin contains iron, which is what makes it a good transporter for the oxygen and carbon dioxide. Red blood cells and white blood cells have the responsibility to cleanse and nourish the body (3). These blood cells and platelets are produced in bone marrow, usually the vertebrae, ribs, hips, skull, etc. The blood cells job is to fight infection, carry oxygen and help control bleeding (10). Plasma is made up of water, proteins, and salts (10). It's a straw-colored, clear liquid that is 90 percent water, and it is an essential ingredient for human survival (rch.org). The main job

Ehmke 5 of plasma is to transport blood cells throughout [the] body along with nutrients, waste products, antibodies, clotting proteins, chemical messengers such as hormones, and proteins that help maintain the body's fluid balance (hematology.org). Once blood is donated, blood banks collect, test, and store the donated blood. The blood banks check the blood for infectious agents, such as viruses, or any disease that may cause illness. Blood banks also screen each blood donation to find out whether it's type A, B, AB, or O and whether it's Rh-positive or Rh-negative (9). This is important, due to the sickness produced if a blood type is received and is incompatible with the body's normal blood type. Thus, blood banks carefully test donated blood (9). A [b]lood transfusion is [an average procedure in which blood is transferred,] or bloodbased products [are transferred, from one person into the circulatory system of another (6). People usually receive blood transfusions if there has been a lot of blood lost during surgery or a serious injury. Also, this procedure may be done if the body has trouble regenerating blood due to an illness. In order to have a blood transfusion, a tiny needle is used to insert an IV line into a blood vessel. This line will then transfer the healthy blood into the body. This may take up to four hours, depending on the amount of blood being transfused. Although blood transfusions are very ordinary, mild complications may occur (9). The main risks of blood transfusions are: allergic reactions, viruses and infectious diseases, fever, iron overload, lung injury, acute immune hemolytic reaction, delayed hemolytic reaction, graft-versus-host disease, and bacterial contamination (9)(1). Allergic reactions may occur even if the blood type matches perfectly. These reactions can be mild to severe. A nurse or doctor will stop the transfusion immediately if any sign of a reaction is occurring. The symptoms include: anxiety, chest or back pain, trouble breathing,

Ehmke 6 fever, chills, flushing, clammy skin, quick pulse or low blood pressure, and nausea (9). Viruses and infectious diseases can live in blood and can infect the person who is receiving the blood. In order to prevent this, blood banks screen the blood carefully. The risk of getting an infectious disease is very low. The three main viruses or infectious diseases that may be transmitted are HIV, Hepatitis B and C, and Variant Creutzfeldt-Jakob disease (9). One in two million donations transmit HIV to a patient, even though all donated blood is tested for the virus. Also, all donors are questioned prior to giving blood. Questions are asked, to the donors, about whether any signs or symptoms of the virus have occurred. The risk of having a donation with Hepatitis B is one in two hundred thousand to three hundred and sixty thousand. For Hepatitis C it is one in one to two million. If a patient receives blood that has Hepatitis, it is almost guaranteed that the virus will transfer into the patients bloodstream. The risk of obtaining Variant Creutzfeldt-Jakob (vCJD), from blood transfusions, is very low, however there is still a risk so people who have been exposed to vCJD aren't eligible to donate blood. This disease is a humanized version of Mad Cow disease. This is a fatal, but very rare, brain disorder (9). A mild symptom of blood transfusions is fever. This is a normal response to the white blood cells from the donated blood. Over-the-counter medicine will treat the fever. Some blood banks remove white blood cells to reduce this reaction risk (9). An iron overload may occur by having a lot of blood transfusions. Iron overload can damage [the] liver, heart, and other parts of the body (9). If there is iron overload in the body, iron chelation therapy may be recommended. Through this, medicine will be given and will remove any extra iron from the body (9). On rare occasions, blood transfusions may damage the lungs, which will make it hard to breathe. Usually patients recover. However, some patients also die. Doctors aren't completely

Ehmke 7 sure why blood transfusions damage the lungs. [However, scientists] believe plasma may play a large role in the lung damage [due to the different] antibodies (proteins) found in [pregnant women] (9). Hemolytic reactions destroy the patients immune system. Today, getting this reaction would be very rare due to the blood screening prior to receiving the blood (nlm.nih.gov). An acute immune hemolytic happens if the patient gets the wrong blood type during the transfusion. The body attacks the different red cells, which then produce harmful substances for the kidneys. Symptoms may include: chills, fever, nausea, pain in chest or back, and dark urine. A delayed hemolytic reaction is a slower version of an acute immune hemolytic reaction. The body destroys red blood cells and doctors don't realize it until the patient's red blood cell level is fatally low (9). To prevent these reactions, the patient and donor's blood are tested to see if the bloods are compatible. This test consists of a small amount of both bloods being mixed together and then being observed under a microscope for an antibody reaction (8). GVHD (graft-versus-host disease) is a disease where white blood cells from the new blood, attack the tissues. This usually ends fatally. Also, this generally occurs in patients with weak immune systems. Symptoms from this disease start about a month after the blood transfusion. The symptoms include: fever, rash, and diarrhea. To prevent GVHD, donated blood can be treated (9). Blood transfusions may also cause bacterial contamination. Bacteria may already be inside of the blood pack during the blood donation or processing. Bacteria will most likely multiply and reproduce during storage. Symptoms of this contamination may include: very high fever, rigor, hypotension, nausea, and diarrhea (1). Although blood transfusions may have many cons, the procedure is still a vital asset to

Ehmke 8 the nations society. The advantages that blood transfusions have are: increasing low hemoglobin levels, the ability to help stop bleeding, keeping the heart pumping, assisting with blood infections, providing red cells and platelets when bone marrow is compromised, and providing red cells and platelets for patients with blood disorders. Without blood transfusions low hemoglobin would cause damage to the body's organs and tissues due to the low oxygen levels. Also, bleeding would not be able to be controlled if platelets or clotting factors were low. Blood transfusions are crucial to saving lives, without blood transfusions, low blood volume could lead to low pressure, and the heart would not be able to maintain the circulation of blood (Rubin, Billie). Surgeries also play a large role in the importance of blood transfusions due to the large loss of blood during the procedures (9). Most importantly, blood transfusions have saved and will continue to save many people's lives (7).

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