A
blood bank is a cache or bank of
bloodBlood is a specialized bodily fluid in animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells....
or
blood components, gathered as a result of
blood donationA blood donation occurs when a person voluntarily has blood drawn and used for transfusions or made into medications by a process called fractionation....
, stored and preserved for later use in
blood transfusionBlood transfusion is the process of receiving blood products into one's circulation intravenously. Transfusions are used in a variety of medical conditions to replace lost components of the blood...
. The term "blood bank" typically refers to a division of a hospital laboratory where the storage of blood product occurs and where proper testing is performed to reduce the risk of transfusion related events. It is important for a blood bank to pass all the eligibility guidelines as mandated by the National Health Service (NHS) and Food and Drug Administration (FDA). The safety and reliability should also be a consideration too. This includes compatibility testing for transfusion and may include blood donation processing, depending on the capabilities of the facility.
Transfusion
Most hospital blood banks also perform testing to determine the
blood typeA blood type is a classification of blood based on the presence or absence of inherited antigenic substances on the surface of red blood cells . These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system...
of patients and to identify compatible blood products for blood transfusions, along with a battery of tests (e.g. disease) and treatments (e.g. leukocyte filtration) to ensure and enhance quality. Some such procedures can be done "upstream" by the collecting agency, or a contracted laboratory. The increasingly recognized problem of inadequate efficacy of transfusion and post-transfusion complications raises the importance of quality testing and screening; U.S. hospitals spend more on dealing with the consequences of transfusion-related complications than on the combined costs of buying, testing/treating, and transfusing their blood.
Donors are sometimes paid; in the U.S. and Europe, most blood for transfusion is collected from volunteers while plasma (specifically
blood plasmaBlood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...
) for manufacturing is from paid donors.
In the US, certain standards are set for the collection and processing of each blood product. "Whole blood" (WB) is the proper name for one defined product, specifically unseparated venous blood with an approved preservative added. Most blood for transfusion is collected as whole blood. Autologous donations are sometimes transfused without further modification, however whole blood is typically separated (via centrifugation) into its components, with Red Blood Cells (RBC) in solution being a commonly used product. Units of WB and RBC are both kept refrigerated at 1-6 C, with maximum permitted storage periods (shelf lives) of 35 and 42 days respectively.
Red Blood Cell units can also be frozen when buffered with glycerol, but this is an expensive and time consuming process, and is rarely done. Frozen red cells are given an expiration date of up to 10 years and are stored at -65C.
The less-dense
blood plasmaBlood plasma is the straw-colored liquid component of blood in which the blood cells in whole blood are normally suspended. It makes up about 55% of the total blood volume. It is the intravascular fluid part of extracellular fluid...
is made into a variety of frozen components, and is labeled differently based on when it was frozen and what the intended use of the product is. If the plasma is frozen promptly and is intended for transfusion, it is typically labeled as
fresh frozen plasmaThe term fresh frozen plasma refers to the liquid portion of human blood that has been frozen and preserved after a blood donation and will be used for blood transfusion...
. If it is intended to be made into other products, it is typically labeled as recovered plasma or plasma for
fractionationSee also: Fractionated spacecraftFractionation is a separation process in which a certain quantity of a mixture is divided up in a number of smaller quantities in which the composition changes according to a gradient. Fractions are collected based on differences in a specific property of the...
.
CryoprecipitateCryoprecipitate, also called "Cryoprecipitated Antihemophilic Factor", "Cryoprecipitated AHF", and most commonly just "cryo", is a frozen blood product prepared from plasma.It is often transfused as a four to six unit pool instead of as a single product...
can be made from other plasma components. These components must be stored at -18C or colder, but are typically stored at -30C.
The layer between the red cells and the plasma is referred to as the
buffy coatThe buffy coat is the fraction of an anticoagulated blood sample after density gradient centrifugation that contains most of the white blood cells and platelets.-Description:...
and is sometimes removed to make platelets for transfusion. Platelets are typically pooled before transfusion and have a shelf life of five days, or three days once the transfusion centre that collected them has completed their tests. Platelets are stored at room temperature (20-24C) and must be agitated. Since they are stored at room temperature in nutritive solutions, they are at high risk for growing
bacteriaBacteria are a large domain of prokaryotic microorganisms. Typically a few micrometres in length, bacteria have a wide range of shapes, ranging from spheres to rods and spirals...
.
Some blood banks also collect products by
apheresisApheresis is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation...
. The most common component collected is plasma via
plasmapheresisPlasmapheresis is the removal, treatment, and return of blood plasma from blood circulation. It is thus an extracorporeal therapy...
, but red blood cells and platelet can be collected by similar methods. These products have the same shelf life and storage conditions as their manually produced counterparts. An ongoing study allows platelets collected by apheresis to be kept for seven days, but only with specific microbiological testing. The lack of a preservative solution makes a longer shelf life of little use.
Short-term Storage
Routine blood storage is limited to 21 days at 1°- 6°C when treated with
acid-citrate-dextroseAcid Citrate Dextrose Solution is a solution of citric acid, sodium citrate and dextrose in water. It is mainly used as an anticoagulant to preserve blood specimens required for tissue typing, it is also used during procedures such as plasmapheresis instead of heparin...
(ACD), citrate-phosphate-dextrose (CPD) or citrate-phosphate-double dextrose (CP2D) and 35 days when treated with citrate-phosphate-dextrose-adenine (CPDA1) (
5 weeks for WB, 6 weeks for RBC), and involves refrigeration but usually not freezing. There has been increasing controversy about whether the age of blood is a factor in transfusion efficacy, specifically on whether older blood directly or indirectly increases risks of complications. Studies have not been consistent on answering this question, with some showing that older blood is indeed less effective but with others showing no such difference; nevertheless, as storage time remains the only available way to estimate quality status or loss, a
first-in-first-out inventory management approach is standard presently.
Insufficient transfusion efficacy can result from blood product units damaged by so-called
storage lesion - a set of biochemical and biomechanical changes which occur during storage. With red cells, this can decrease viability and ability for tissue oxygenation. (Note that upon transfusion, cells have exhibited some degree of ability to reverse their storage lesion, albeit not entirely - and often too slowly to benefit urgent-care patients.) Without a clinically feasible and reliable means to directly measure this phenomenon (during storage), many physicians have adopted a so-called "restrictive protocol" - whereby transfusions are simply being held to a minimum, as delayed recovery times and extended hospitals stays is viewed as the "lesser evil" compared to the harm and thus resulting cost of transfusing blood product of unknown quality.
Long-term Storage
Long-term storage is relatively uncommon, compared to short-term storage.
CryopreservationCryopreservation is a process where cells or whole tissues are preserved by cooling to low sub-zero temperatures, such as 77 K or −196 °C . At these low temperatures, any biological activity, including the biochemical reactions that would lead to cell death, is effectively stopped...
of red blood cells is done to store rare units for up to 10 years. The cells are incubated in a
glycerolGlycerol is a simple polyol compound. It is a colorless, odorless, viscous liquid that is widely used in pharmaceutical formulations. Glycerol has three hydroxyl groups that are responsible for its solubility in water and its hygroscopic nature. The glycerol backbone is central to all lipids...
solution which acts as a
cryoprotectantA cryoprotectant is a substance that is used to protect biological tissue from freezing damage . Arctic and Antarctic insects, fish, amphibians and reptiles create cryoprotectants in their bodies to minimize freezing damage during cold winter periods. Insects most often use sugars or polyols as...
("antifreeze") within the cells. The units are then placed in special sterile containers in a freezer at very cold temperatures. The exact temperature depends on the glycerol concentration.
History
An early development leading to the establishment of blood banks occurred in 1915, when Richard Lewison of
Mount Sinai HospitalMount Sinai Hospital, founded in 1852, is one of the oldest and largest teaching hospitals in the United States. In 2011-2012, Mount Sinai Hospital was ranked as one of America's best hospitals by U.S...
in
New York CityNew York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...
initiated the use of
sodium citrateMonosodium citrate, or sodium dihydrogen citrate, is an acid salt with the chemical formula NaH2C6H5O7, or C3H4OH2COONa. Since it has two remaining open spots on the citrate anion, it is used as a relatively strong sequestrant. It is used to prevent platelet clumping in blood samples...
as an
anticoagulantAn anticoagulant is a substance that prevents coagulation of blood. A group of pharmaceuticals called anticoagulants can be used in vivo as a medication for thrombotic disorders. Some anticoagulants are used in medical equipment, such as test tubes, blood transfusion bags, and renal dialysis...
. This discovery transformed the blood transfusion procedure from direct (vein-to-vein) to indirect. In the same year, Richard Weil demonstrated the feasibility of refrigerated storage of anticoagulated blood. The introduction of a citrate-glucose solution by
Francis Peyton Rous Peyton Rous born in Baltimore, Maryland in 1879 and received his B.A. and M.D. from Johns Hopkins University. He was involved in the discovery of the role of viruses in the transmission of certain types of cancer...
and JR Turner two years later permitted storage of blood in containers for several days, thus opening the way for the first "blood depot" established in
BritainThe United Kingdom of Great Britain and Ireland was the formal name of the United Kingdom during the period when what is now the Republic of Ireland formed a part of it....
during
World War IWorld War I , which was predominantly called the World War or the Great War from its occurrence until 1939, and the First World War or World War I thereafter, was a major war centred in Europe that began on 28 July 1914 and lasted until 11 November 1918...
.
In Russia
Sergei YudinSergei Sergeevich Yudin was a Russian surgeon.Sergei Yudin was an outstanding Russian surgeon of the 20th century. Yudin lived a very productive, yet tragic, life....
pioneered the transfusion of cadaveric blood and performed this successfully for the first time on March 23, 1930. Also in 1930 Yudin organized the world's first blood bank at the Nikolay Sklifosovskiy Institute, which set an example for the establishment of further blood banks in different regions of the
Soviet UnionThe Soviet Union , officially the Union of Soviet Socialist Republics , was a constitutionally socialist state that existed in Eurasia between 1922 and 1991....
and in other countries. By the mid-1930s the Soviet Union had set up a system of at least sixty five large blood centers and more than 500 subsidiary ones, all storing "canned" blood and shipping it to all corners of the country.
News of the Soviet experience traveled to the United States, where in 1937
Bernard FantusBernard Fantus was a Hungarian American physician. He established the first hospital blood bank in the United States in 1937 at Cook County Hospital, Chicago while he served there as director of the pharmacology and therapeutics department.Fantus was born in Budapest, Hungary...
, director of therapeutics at the Cook County Hospital in
ChicagoChicago is the largest city in the US state of Illinois. With nearly 2.7 million residents, it is the most populous city in the Midwestern United States and the third most populous in the US, after New York City and Los Angeles...
, established the first hospital blood bank in the United States. In creating a hospital laboratory that preserved and stored donor blood, Fantus originated the term "blood bank." Within a few years, hospital and community blood banks were established across the United States.
Willem Johan KolffWillem Johan "Pim" Kolff was a pioneer of hemodialysis as well as in the field of artificial organs. Willem is a member of the Kolff family, an old Dutch patrician family. He made his major discoveries in the field of dialysis for kidney failure during the Second World War...
organised the first blood bank in Europe (in 1940).
In 1939
Charles R. DrewCharles Richard Drew was an American physician, surgeon and medical researcher. He researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge to developing large-scale blood banks early in World War II. This allowed medics to...
researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge in developing large-scale blood banks early in World War II.
Oswald Hope RobertsonOswald Hope Robertson was an English-born medical scientist who pioneered the idea of blood banks in the "blood depots" he established in 1917 during service in France with the US Army Medical Corps.- Life :...
, a medical researcher and
U.S. ArmyThe United States Army is the main branch of the United States Armed Forces responsible for land-based military operations. It is the largest and oldest established branch of the U.S. military, and is one of seven U.S. uniformed services...
officer who established the depots, is often regarded as the creator of the first blood bank. The
University of LouisvilleThe University of Louisville is a public university in Louisville, Kentucky. When founded in 1798, it was the first city-owned public university in the United States and one of the first universities chartered west of the Allegheny Mountains. The university is mandated by the Kentucky General...
is also credited for the Blood Bank.
An important breakthrough came in 1939-40 when
Karl LandsteinerKarl Landsteiner , was an Austrian-born American biologist and physician of Jewish origin. He is noted for having first distinguished the main blood groups in 1900, having developed the modern system of classification of blood groups from his identification of the presence of agglutinins in the...
, Alex Wiener, Philip Levine, and R.E. Stetson discovered the Rh blood group system, which was found to be the cause of the majority of transfusion reactions up to that time. Three years later, the introduction by
J.F. LoutitJohn Freeman Loutit CBE FRS FRCP Also known as 'Ian'. was an Australian haematologist and radiobiologist.He was born in Western Australia, the son of a locomotive engineer....
and Patrick L. Mollison of
acid-citrate-dextroseAcid Citrate Dextrose Solution is a solution of citric acid, sodium citrate and dextrose in water. It is mainly used as an anticoagulant to preserve blood specimens required for tissue typing, it is also used during procedures such as plasmapheresis instead of heparin...
(ACD) solution, which reduces the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer term storage.
Carl Walter and W.P. Murphy, Jr., introduced the plastic bag for blood collection in 1950. Replacing breakable glass bottles with durable plastic bags allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of Whole Blood.
An anticoagulant preservative, CPDA-1 was introduced in 1979. It decreased wastage from expiration and facilitated resource sharing among blood banks. Newer solutions contain
adenineAdenine is a nucleobase with a variety of roles in biochemistry including cellular respiration, in the form of both the energy-rich adenosine triphosphate and the cofactors nicotinamide adenine dinucleotide and flavin adenine dinucleotide , and protein synthesis, as a chemical component of DNA...
.
See also
- Blood donation
A blood donation occurs when a person voluntarily has blood drawn and used for transfusions or made into medications by a process called fractionation....
- Phlebotomist
Phlebotomists are individuals trained to draw blood from a live person or animal.Phlebotomists collect blood primarily by performing venipuncture and, for collection of minute quantities of blood, fingersticks. Blood may be collected from infants by means of a heel stick...
- Charles R. Drew
Charles Richard Drew was an American physician, surgeon and medical researcher. He researched in the field of blood transfusions, developing improved techniques for blood storage, and applied his expert knowledge to developing large-scale blood banks early in World War II. This allowed medics to...
- Sergei Yudin
Sergei Sergeevich Yudin was a Russian surgeon.Sergei Yudin was an outstanding Russian surgeon of the 20th century. Yudin lived a very productive, yet tragic, life....
- Medical technologist
A Medical Laboratory Scientist is a healthcare professional who performs chemical, hematological, immunologic, microscopic, and bacteriological diagnostic analyses on body fluids such as blood, urine, sputum, stool, cerebrospinal fluid , peritoneal fluid, pericardial fluid, and synovial...
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