Five Quarts: A Personal and Natural History of Blood (22 page)

“Yes,” he nodded. “And the most significant in transfusion therapy are the best known—A, B, AB, and O.”

Sure, anyone who’s donated blood knows these letters. And of course I couldn’t help noticing them prominently displayed on every blood product. This hematological safety code devised in 1901 put an end to hundreds of years of dangerous blood transfusions, I knew. As is often the case with scientific breakthroughs of this sort, the discovery of blood types began unceremoniously, with a curious individual trying to unknot a puzzle. Austrian pathologist Karl Landsteiner could not fathom why adding a bit of one person’s blood into test tubes of other people’s blood caused such varying results. Sometimes the red cells bunched together, sometimes they burst, and sometimes there was no reaction at all. Now, this was not an unknown phenomenon. Earlier scientists had concluded that these cellular dynamics were due to a clash between healthy and sick blood. Landsteiner, however, was using only the blood of healthy subjects, including his own. With the kind of glee I imagine only the fussiest scientists having, Landsteiner pulled out his graph paper. He mixed and mixed and mixed, taking careful notes and charting his findings. Patterns emerged, and he identified three groupings of blood—blood groups—which he labeled A, B, and C. (C later became O.) As it turned out, Landsteiner belonged to this last group, type O, making him what is now called a universal donor. In terms of his experiment, this meant that his red cells didn’t react to any other specimens, which, in an odd way, is the aspect of his story I enjoy most. Even his cells, it seems, were dispassionate observers.

In a more technical sense, what Landsteiner had documented was a classic antibody-antigen response. For the purpose of illumination, consider a patient with type A blood (which means his red cells have the A antigen). If wrongly infused with type B blood, his body will immediately launch an assault: his antibodies versus the foreign red cells. (A similar scenario will play out if a type B patient is given type A blood, or if a type O patient is transfused with either A or B blood.) It’s not surprising that, in his initial experiment, Landsteiner missed the fourth blood type, AB, which, for example, is found in only 4 percent of the U.S. population. These individuals are called universal recipients because they can safely receive any blood type.

One last major antigen is noteworthy here, antigen D, whose presence or absence is indicated with an Rh+ (“Rhesus-positive”) or an Rh-. If an Rh- woman is carrying an Rh+ child, the mother-to-be may produce antibodies that will threaten the baby’s life, a condition that, fortunately, can be identified and treated. Karl Landsteiner co-discovered the Rh blood factor in 1940, ten years after winning the Nobel Prize for his ABO blood grouping system.

Richard cleared his throat. In addition to the A’s, B’s, and D’s, he explained, “There are literally hundreds of other antigens and proteins—both on the red cell surface and embedded in the red cell membrane—that are ‘genetically informed.’ ” Normally, these don’t figure prominently when a person needs blood. Some people are born with unusual blood, however, and others develop it. For instance, patients who have received multiple transfusions may have accrued antibodies to these minor antigens. Over time these individuals become harder and harder to match with suitable blood. That’s where this specialized lab comes in. As Richard explained, the researchers obtain samples of blood from hospitals throughout Northern California and test and catalog these unusual antibodies, antigens, and proteins. The lab also houses a national rare donor blood registry and provides a round-the-clock consultation service for hospitals trying to hunt down rare blood.

“The thing about rare blood is, it’s
rare,
so people don’t need it very often. But when they need it, they need it
now
!” By means of demonstration, we stepped into a nearby room with a small rumbling fridge. Richard randomly pulled out a pouch of red cells and read off for me a sampling of its unusual markers: “So this unit is big C positive, little e negative, little c negative, big E—these are all different antigens, these are Rh—and this is Kell . . . big K and little k; Duffy a, Duffy b; Jk(a) and (b), M, N, S, Lutheran, and Kinney!” Had I not glanced over the list, I’d have thought he’d made up some of those last ones. But no, this specific blend will likely be called for today, he predicted, and within hours will be coursing through someone’s bloodstream.

While at any given moment a small number of fresh units are available, the bulk of the center’s inventory is frozen. A quick walk took us to the deep freeze, a dim room dominated by eight coffin-style industrial freezers. You could probably fit several bodies into just one, I figured, and in fact the eleven hundred units stored within each do add up to about twenty quarts of blood, or four bodies’ worth. Richard creaked open the hood of the closest vault. Iced-over metal containers the size of clipboards were arranged like hanging files. Inside these, he explained, the cells are a thin red crust. When a hospital requisitions a unit, “It is thawed in a seawater bath at body temperature”—which struck me as a lovely way to emerge from so harsh a hibernation. Next, the “antifreeze” is removed, leaving the red cells ready to be shipped and transfused. The sell-by date for deep-frozen blood has yet to be established, Richard noted. Ten years is the industry guesstimate, but, he ventured, “It probably is almost good forever.”

As Richard steered me back to where the tour had begun, I marveled at the support structure in place here within this enormous stretch of a building: a staff of 350, a thirty-million-dollar annual budget, a steady hum of technology, all devoted to sustaining these small bags of fluid and readying them for their eventual return to circulation. While I’m sure it wasn’t Richard’s intent, my witnessing the effort expended on blood’s behalf actually left me more in awe of what the center tries so hard to replicate, the perfect packaging of the human body.

Back in the collection area, one such specimen sat within the contour cushions of the blood center’s latest high-tech toy, the e-chair. Richard said in the quiet voice of golf commentary, “This is the wave of the future.” He gently pulled me off to the side so we wouldn’t be hovering too close to the young Latino donor. The e-chair, Richard explained, is a six-months-new machine that, in one sleek apparatus, performs all the tasks of the Component Lab. It does this by extending the circulatory system by a few feet. The donor’s blood passes through tubing that disappears into a chairside contraption, about the size of a two-drawer filing cabinet. Inside is a whirring centrifuge. The wonder of this machine, Richard said, is that you can program its computer to harvest only the specific cells you need. The unneeded blood is then neatly transfused back into the body through a second tube. The technical name for this process is
apheresis,
which sounded to my ear like a condition requiring anti-itch cream but, in fact, comes from the Greek for “to separate.”

To underscore the machine’s efficiency, Richard had me imagine the typical pouch of whole blood that’s collected in a standard donation, from which only a tiny squirt of platelets is derived. In a single apheresis session, he stressed, five times the number of platelets can be withdrawn without removing a single red cell.

One aspect of the e-chair setup that’s consistent with the traditional method is that the blood collection bags are not in the donor’s direct line of sight. This, I am certain, is for the best. No matter how soothing the phlebotomist’s manner or how frequently the donor donates, I don’t believe a person could stare directly at that transparent pouch as he or she drains into it without having a visceral reaction. I suppose this could be considered the most primal form of separation anxiety: a person from his or her own blood.

At this moment the young donor was being separated from both platelets and plasma. Richard pointed out the two corresponding pouches hanging behind his shoulders. The technology is cost-efficient in so many ways, Richard enthused, allowing his inner accountant to romp—lower labor costs, less lab time, fewer blood tests, the ability to maximize the contribution of a single donor. It’s also safer for patients who receive the products. He used the example of someone being treated for severe leukemia. Such a person would likely need an infusion of platelets every other day for five months. As I’d already learned, one infusion is typically a pooling of five people’s platelets. With apheresis, however, the product comes from just one donor. Thus the potential for a bad transfusion reaction is slashed 80 percent.

The only drawback, he conceded, is the time commitment required of the donor—ninety minutes as opposed to the usual half hour it takes to give a pint of blood. That’s where the
e
in
e-chair
comes in. A mounted computer screen and keyboard let you access the Internet, listen to CDs, or watch TV or movies. A five-foot-tall, fully stocked DVD carousel stood off to the side. Conceivably, you can catch up on office work and e-mail while giving blood (though it helps if you’re a good one-handed typist, since one arm is locked down with tubing).

The current donor, wearing earphones, was about an hour into watching the movie
X-Men
and looked completely absorbed. Of course, I wouldn’t have wanted to disturb him—Mystique was just about to sabotage the mutant-detecting device Cerebro—but I was curious to know his story. One of the technicians had mentioned to us that he was a first-time donor, and Richard had quietly noted that he was much younger than their typical volunteer. In order to earn a seat in this e-chair, I knew, he’d had to pass an extensive donor screening centered on a medical history survey with forty-three yes-or-no questions. In the strictest sense, these questions are designed to eliminate groups of people. The first fifteen, asked during a brief one-on-one interview, are intimate in nature but clinical in wording. The questionnaire is also ever-evolving. As there is not yet a blood test for the human variant of mad cow disease, for example, questions regarding past travel to the United Kingdom were added to disqualify the possibly exposed. However, there’s no space provided for elaboration—no room for the
Well, yes, but
s, as in,
Yes, I did stay in England for a summer, but I’m a strict vegan, so beef never crossed my lips. . . .
The screening doesn’t bend. Nor does it address a broader field of inquiry, the prospective donor’s character and intent, which, granted, has no bearing on the quality of the blood itself and, in any case, would be hard to assess through simple yeses or nos. Even so, this eliminates the first question I would ask of a person, one that’s far too open-ended to be practical but whose answer I’d still like to hear:
So tell me, why do you want to give your blood?

Someone needs help, you do what you can. Call 911. Stop at the scene of an accident. Or help chase the oranges when an old lady’s grocery bag breaks. Any good person would hardly think twice. Granted, because of where I reside (San Francisco, on a spider’s throne of fault lines); where I live (off a busy intersection without traffic lights, the site of countless fender benders); and where I work (at home, alone, which involves a fair amount of staring out the window, daydreaming), maybe I do give this more thought and put the sentiment into practice a tad more often than most. (
Too
eagerly, too, a certain neighbor could claim, as when I reported a fire one lovely evening last summer upon seeing flames leaping from behind the backyard fence of his building across the way. Four fire trucks converged, the building was evacuated, the street blocked off. I stepped outside into the scene I’d tipped into motion and felt a tug of war between
God, I hope it’s not a bad fire
and
God, I hope it is.
Not a lick of flame was visible from out here, so the tenants milling about wore looks of inconvenience or irritation rather than fear. I stood next to a woman in slippers cradling a bowl of goldfish when the word came: “It was just a barbecue, and some dumb stupid idiot in love with his lighter fluid.” I appreciated the fireman’s redundancy as much as his comment once he’d learned I’d made the call: “You did exactly the right thing.”) So in any event, when a call went out for Bay Area blood donors a few years ago—
Urgent Need! Critical Shortage!
—on TV news and in the papers, I thought,
Yeah, sure, I’ll give blood. I’m perfectly healthy. Needles don’t scare me. Blood, either.

When I was growing up, a citizen’s duty to donate blood was instilled at home, school, and church. It was a patriotic gesture, like voting, only young people could also do it. That giving blood was synonymous with citizenship was a message that even made its way into one of the comic books I read as a kid. In
Action Comics
#403 (August 1971), the good people of Metropolis were asked to participate in a one-of-a-kind blood drive. Calling all able-bodied volunteers: Superman needs a blood transfusion! Reading it today, I have to wonder if I paid attention at all back then to the science of the story, if you can even call it science. You see, Superman is infected with a killer microorganism, a sentient menace that has set up camp in his bloodstream. With just two days to live, the Man of Steel must find a way to outconnive the conniving “Micro-Murderer.” The only solution, doctors determine, is to flush the microbe from Superman’s body using hundreds of gallons of blood. The comic-book doctors call this a transfusion, but it’s really more a circulatory system colonic. Superman makes a televised plea for blood, and the citizens of Metropolis can’t move fast enough to go donate. Having been saved countless times over by the alien Man of Steel, these everyday people are overjoyed to have a tangible way to give back.

To be honest, I’d have recalled little of this story had Steve not dug up a copy for me. The cover, on the other hand, was far more familiar, not for the striking image of Superman lying unconscious on a gurney but for the fact that the third person in line to donate blood is singer David Crosby circa the 1970
Déjà Vu
album, or, at the very least, a remarkable look-alike. In front of David is a boy who looks the age I’d have been when the comic was brand new, though the kid’s on crutches and has a leg cast so I can’t help but wonder how he won the race to be first in line. For the sake of a single dramatic cover image, the artist shows the transfusion already under way. The collected blood, in a huge IV hanging over the hero’s head, is the same Superman-red as his boots, briefs, cape, and the bright
S
on his chest.