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View Full Version : Is it possible to transfuse blood at the site of an accident?



MissMacchiato
10-15-2010, 04:52 AM
As the thread title says, how hard would it be to do a blood transfusion at the site of an accident?

What would it involve, or what supplies would the medic need?

I can't imagine what it would look like, could the blood be injected? haha, I really have no idea at all here...

Drachen Jager
10-15-2010, 05:07 AM
They're not equipped for that.

MissMacchiato
10-15-2010, 05:18 AM
so, there's no way a doctor could get out his magical black bag, pull out a sack of blood and just hook it up?

(LOL!)

Bugger. Well, that screws up THAT plot point.

thothguard51
10-15-2010, 05:24 AM
Unless the victim was wearing a ID bracelet or dog tag with blood type listed, how would the doctor, or EMT's know what type of blood to use? And there is always the chance the victim ID was not their own, and no doctor is going to take the chance.

Hooking up an IV is about as good as its going to get. That and stopping the bleeding by using a blood coagulating powder...

MissMacchiato
10-15-2010, 05:27 AM
This is going in an urban fantasy story, so they have the skill to detect the blood type. I'm just wondering what limitations would prevent someone from doing a transfusion, so this info is great.

I couldn't find much info on the step by step process of blood transfusion anywhere, so it's hard to say whether it would be wildly outside the bounds of possibility or not.

thothguard51
10-15-2010, 05:48 AM
Well, even if they can type the blood at the scene, how many EMT's or Doctors are going to carry around a variety of blood types. Blood is perishable...

Does this take place in a inaccessible location, like a airliner crash on an island where a hospital is not an option and its a matter of life and death at that very moment? Remember, the bleeding has to be stopped first, and if a very large vein has been damaged, a transfusion alone is not going to help. Transfusions are usually given after the patient has been stabilized and needs the quick infusion to help recover.

I went through quadruple bypass and did not even have 1 pint of blood transfused because they had me hooked to a heart and lung machine. I lost very little blood...

profen4
10-15-2010, 06:18 AM
O-negative is universal. Anyone can receive O neg. so they don't need to know blood type, as long as that's the type they're giving. quan lot nam (http://doxinh.com/danh-muc/do-lot-nam/quan-lot-nam/) do ngu goi cam (http://doxinh.com.vn/danh-muc/do-ngu/) thoi trang be gai cao cap (http://doxinh.vn/danh-muc/thoi-trang-tre-em/thoi-trang-be-gai/) vay cong so nu (http://trangbanbuon.com/danh-muc/thoi-trang-cong-so/vay-cong-so/) ban buon quan ao (http://trangbanbuon.vn/) chup anh da ngoai dep nhat (http://roses.vn/studio/chup-anh-studio/chup-anh-da-ngoai/)

MissMacchiato
10-15-2010, 06:28 AM
She's had some of her blood taken out by a thirsty vampire, and they just want to put some more in before they sew her up, haha!

I think it'd be possible. I'll see if I can find some youtube vids of blood transfusions too.

Thanks everyone!

profen4
10-15-2010, 06:30 AM
She's had some of her blood taken out by a thirsty vampire, and they just want to put some more in before they sew her up, haha!

I think it'd be possible. I'll see if I can find some youtube vids of blood transfusions too.

Thanks everyone!

LOL - they don't put the blood back in the same hole it came out of :) They'd not wait to sew her up. LOL but that would be a funny scene to read if that's what they were doing.

Williebee
10-15-2010, 06:37 AM
So, here's my theory, suitable for fiction only:

She's lost a lot of blood. Almost all. If we don't get some in her she'll die.

Lay her down on the ground next to the car. You grab the t-shirt and duct tape and try to seal those wounds. I've got an idea! I've got some vacuum tubing from my aquarium repairs leftover in the trunk. You got a couple of ink pens? We'll cut off the brass, uncontaminated by ink sections at a slant and fit them, snug, inside the ends of the tubing. Take the point made from the slants and fit one into her vein. I'm O-Neg, so I'll lay back on the hood of the car and fit the other end into one of my veins. Gravity will take care of the rest.

I may pass out, so don't just leave me there bleeding. Got it?



Heck, I don't know. It might work. :)

You're

jclarkdawe
10-15-2010, 06:46 AM
I think the question here is between whether you COULD do it and whether you WOULD do it in the real world.

Normal procedure for a patient that would need a transfusion is scoop and run. You don't want to waste any time. And it takes time for a blood transfusion, because of blood matching and getting the blood. So normally you set up a large bore IV and run like hell. Sometimes when you get the patient to the hospital, the blood is pink because of all the IV solution.

You can't carry blood in an ambulance. All the space is used, and stuff that most crews would love to have on their rigs get left at the station. So you WOULD not deal with a blood transfusion in the present world.

However, COULD you do it? Yeah, and it's not real hard. Real case scenario is that during extended extrications blood transfusions are set up. I know a paramedic who had to do this. Extrication was projected to take from 5 - 8 hours by first medic on the scene. Patient had a large bleed in the lower leg, and was going into shock.

A large bore IV was set up in both arms, but the blood loss could not be controlled because of the entrapment. Patient was a blood donor and knew his blood type. Because of the length of time, and the uncontrolled bleeding, ER doctor authorized two units of blood, which was sent by police cruiser with an ER nurse. Extrication took six hours and resulted in the loss of both legs before the knee, but patient survived.

But this scenario is very much not the norm.

You CAN do blood transfusions in the field, but you normally don't.

Best of luck,

Jim Clark-Dawe

MissMacchiato
10-15-2010, 08:02 AM
hmm. Thanks Clarkie. Interesting stuff.

I wonder how it works in the army. In my theoretical world blood is bought and sold with relative ease.

GeorgeK
10-15-2010, 10:22 AM
So, here's my theory, suitable for fiction only:

She's lost a lot of blood. Almost all. If we don't get some in her she'll die.

Lay her down on the ground next to the car. You grab the t-shirt and duct tape and try to seal those wounds. I've got an idea! I've got some vacuum tubing from my aquarium repairs leftover in the trunk. You got a couple of ink pens? We'll cut off the brass, uncontaminated by ink sections at a slant and fit them, snug, inside the ends of the tubing. Take the point made from the slants and fit one into her vein. I'm O-Neg, so I'll lay back on the hood of the car and fit the other end into one of my veins. Gravity will take care of the rest.

I may pass out, so don't just leave me there bleeding. Got it?



Heck, I don't know. It might work. :)

You're

However, the type of plastics used for those are almost certainly going to set off a blood clotting cascade Resulting in DIC (Disemminated Intravascular Coagulation). If it manages not to do that, then it would almost certainly result in sepsis because there's all sorts of stuff in aquaria.


O-negative is universal. Anyone can receive O neg. so they don't need to know blood type, as long as that's the type they're giving.

ABO is only the first phase of typing. You'd still need to do cross matching. I'm O neg but will not likely ever be able to receive blood because I'm also negative for a half dozen other subtypes that few nonphysicians know about.


. In my theoretical world blood is bought and sold with relative ease.

If you have "farms" of clones of people with no blood antigens (which goes beyond the ABO and Rh systems), then you could have true universal donors. A unit of whole blood will start to die relatively quickly so they typically separate it into parts so stuff like the clotting factors and plasma can be frozen. It's the red cells that carry oxygen and are usually the first to be given. You don't break out the plasma or platelets or cryoprecipitates until later in the game. A unit of packed red cells can last in ideal conditions 6-8 weeks. You also normally only get transfused if you are hemodynamically unstable (low blood pressure, sustained tachycardia), not just because someone looks pale.

Marian Perera
10-15-2010, 12:26 PM
ABO is only the first phase of typing. You'd still need to do cross matching. I'm O neg but will not likely ever be able to receive blood because I'm also negative for a half dozen other subtypes that few nonphysicians know about.

O negative cells and AB positive plasma would contain the fewest antibodies, right? Just going by the ABO and Rh systems, that is.

I'm taking a Transfusion Science course right now and the number of blood group systems makes my head spin.

Kathie Freeman
10-15-2010, 08:14 PM
OK, theoretically, if there is a doctor or paramedic at the scene and if they have needles and tubing, and if there is another person on the scene with O-negative blood type, they could do a person-to-person transfusion. That is how it was routinely done before blood storage became a common practice. Of course the recipient didn't always survive, and they'd have to be careful not to take too much from the donor.

PeterL
10-15-2010, 10:09 PM
Transfusions have been done at accident sites, as Clarke-Dawe pointed out, the military often does such things.That EMTs in the U.S.A. don't do that is a matter of their procedures, rather than the possible. Even without typing the blood they could infuse with plasma.

There is no reason why you couldn't have a transfusion at an accident scene in a novel. That requires less suspension of disbelief than ampires require.

agentpaper
10-16-2010, 07:28 AM
Okay, take this for what it's worth. FICTIONAL USE ONLY!! If you had the correct equipment. Lines, bags, needles, etc, you could potentially remove blood from someone who is around (since they can judge blood types you don't have to worry about using the wrong blood) and then transfer that blood into the other person. YOu wouldn't do this in real life because there's SOOO many things to consider including bloodborne pathogens, but it could work for your world. Especially if you don't have a "real" EMT taking care of her.

GeorgeK
10-16-2010, 09:25 AM
Transfusions have been done at accident sites, as Clarke-Dawe pointed out, the military often does such things.That EMTs in the U.S.A. don't do that is a matter of their procedures, rather than the possible. Even without typing the blood they could infuse with plasma.

Transfusing with plasma is even more impractical and less useful. You need equipment to separate the red cells without activating the clotting cascade. It is very impractical outside a blood bank or hematology lab. It's also less useful because plasma doesn't transport oxygen, Red cells do. Plasma is useful for intravascular volume (but then so is normal saline or ringer's lactate which come in nice sterile packages) and a few coagulopathies, of which having been vamped is not likely to be one, (unless you want it to be so in your world...maybe your vamps have blood thinning saliva like ticks and mosquitoes).




There is no reason why you couldn't have a transfusion at an accident scene in a novel. That requires less suspension of disbelief than vampires require.
True, it is possible and used to be the norm, probably 70 years ago. With what we know now, it is not standard of care, and is risky.


Of course the recipient didn't always survive,

Right, that's the crux.



and they'd have to be careful not to take too much from the donor.

That's actually not too difficult. All you have to do is monitor the donor's heart rate. That will go up prior to any measurable drop in blood pressure.

GeorgeK
10-16-2010, 09:38 AM
O negative cells and AB positive plasma would contain the fewest antibodies, right? Just going by the ABO and Rh systems, that is..

In simplest terms, antigens are on the cells and antibodies are in the serum. (That's a bit oversimplified and assumes a variety of common health issues have not previously taken place, hence the reason we do cross matching despite blood typing)

Theoretically, the packed RBCs, having been separated from the plasma should have no antibodies, since those are in the plasma. In practice though, there probably is some plasma in the packed cells. Also in a direct patient to patient scenario the recipient will get whole blood, not separated blood products.

People with AB blood have both A and B antigens (on the cells), but should have no antibodies to either A or B. People with Type O blood (think of the O as a zero) have neither A or B antigens, but they might have antibodies if they've received a previous transfusion or a Type O mother of a Type A or B child.




I'm taking a Transfusion Science course right now and the number of blood group systems makes my head spin.

MissMacchiato
10-16-2010, 09:46 AM
haha, this is way complex! and fascinating!

I know it's a suspension of belief to begin with, with the vampires, but I do want it to be plausible, I mean, I'd like it to have potential to be true. It COULD work, type thing.

Here is the scene as I've currently written it, for those of a curious nature!


Something flickered briefly in Jason's eyes, then was gone. "You shot her?" At Randall's nod, he shrugged, then began working on the girl, who was apparently out for the count. He quickly inserted a needle into her wrist and hooked a bag of blood up to a small folding stand. Jason poked it, then turned to me. "Portable blood transfusion. It's a vampire innovation. Good, isn't it?" He poked it again, and the red liquid sloshed unpleasantly. Jason continued to talk about the complexities of mobile transfusions, but I couldn't get my eyes off the bag of blood, and my head swam. At least I hadn't fainted.

I decided I wouldn't go into great depth, because the MC and narrator wouldn't know that much herself. Sound plausible? They might need to do it again later, I guess...

Williebee
10-16-2010, 09:52 AM
However, the type of plastics used for those are almost certainly going to set off a blood clotting cascade Resulting in DIC (Disemminated Intravascular Coagulation).

Well, I did say fiction. :)

And on that. It would seem to me that a mature, prudent vampire, would in fact have him or herself a little travel kit of appropriate hardware, and several lifetimes to have learned the skillset, for "emergency access" to blood. Unless the vampires you were referring to were only bad guys.

GeorgeK
10-16-2010, 10:03 AM
Here is the scene as I've currently written it, for those of a curious nature!
...

Wrist IV's are very unlikely to be large enough to accommodate blood. Blood will clot even with the anticoagulants that they add if you try to squeeze it through too small of an IV. You will need it at least in the fleshy part of the forearm.


Well, I did say fiction. :)
.

True, but this thread is a mash of fiction and realism, and I was more pointing out the flaws for those who were leaning more on the realism.

MissMacchiato
10-16-2010, 10:54 AM
Hmmm. Okay. Thanks. I'll change that!

denboo
10-17-2010, 03:17 AM
Don't know about for humans, but in veterinary medicine trauma victims have had autotransfusions if nothing else available. For instance, a major abdominal bleed -- the blood is harvested (aseptically, and collected into a filtering set) from the abdomen and given back to the same animal IV. It gets rid of the need for typing and cross-matching in your story.

But, if there isn't a chest or abdomen full of blood to get it from, then it wouldn't be plausible.

Tsu Dho Nimh
10-19-2010, 06:12 AM
As the thread title says, how hard would it be to do a blood transfusion at the site of an accident?
It is not done.
Transfuse the wrong blood type and you kill the patient.


What would it involve, or what supplies would the medic need?
The medic needs to have a fully certified blood bank technician on the ambulance (or be trained himself), along with a properly inspected BB refrigerator or other device to hold the blood.
Also needs a proper calibrated centrifuge, an incubating chamber, and a lot of reagents that need to be refrigerated. and about 45 minutes to do the crossmatch

while he's doing the crossmatch, who is stopping the bleeding, doing CPR and other EMT stuff?


I can't imagine what it would look like, could the blood be injected? haha, I really have no idea at all here...

No. Not only no, but HELL NO! (ex-blood bank tech).

Tsu Dho Nimh
10-19-2010, 06:23 AM
This is going in an urban fantasy story, so they have the skill to detect the blood type. I'm just wondering what limitations would prevent someone from doing a transfusion, so this info is great.

I couldn't find much info on the step by step process of blood transfusion anywhere, so it's hard to say whether it would be wildly outside the bounds of possibility or not.

Look up AABB crossmatch prodedure

Tsu Dho Nimh
10-19-2010, 06:28 AM
O-negative is universal. Anyone can receive O neg. so they don't need to know blood type, as long as that's the type they're giving.

It's not that easy. ONeg plasma has antibodies against types A and B ... you have to give ONeg cells reconstituted with AB plasma.

And then there are the 100+ other blood groups. Getting Kell+ blood when you have anti-Kell antibodies in your blood can kill you. There si a screenig procedure for these less common antibodies, but it's not instant, and an ambulance crew has better things to do.

**********
If this is an urban fantasy ... make magical blood that doesn't need preserving, has no diseases, and matches everyone.

Tsu Dho Nimh
10-19-2010, 06:41 AM
As written - the scene is OK ... as soon as you have vampires, the AABB regulations stop applying.

However, the back of the hand or the veins in the forearm are bigger and easier to stick a needle into for transfusions. That needle is HUGE!

GeorgeK
10-19-2010, 03:24 PM
Don't know about for humans, but in veterinary medicine trauma victims have had autotransfusions if nothing else available. For instance, a major abdominal bleed -- the blood is harvested (aseptically, and collected into a filtering set) from the abdomen and given back to the same animal IV. It gets rid of the need for typing and cross-matching in your story.

But, if there isn't a chest or abdomen full of blood to get it from, then it wouldn't be plausible.

They were called cell savers when I was using them, and were about the size of a fully packed military backpack, on wheels.

GeorgeK
10-19-2010, 03:27 PM
It's not that easy. ONeg plasma has antibodies against types A and B ... you have to give ONeg cells reconstituted with AB plasma.
.

That's oversimplified to the point of being wrong, but on a practical level in the event that you can't do crossmatching would be the only safe assumption.

Kallithrix
10-20-2010, 08:40 PM
Here is the scene as I've currently written it, for those of a curious nature!

Something flickered briefly in Jason's eyes, then was gone. "You shot her?" At Randall's nod, he shrugged, then began working on the girl, who was apparently out for the count. He quickly inserted a needle into her wrist and hooked a bag of blood up to a small folding stand. Jason poked it, then turned to me. "Portable blood transfusion. It's a vampire innovation. Good, isn't it?" He poked it again, and the red liquid sloshed unpleasantly. Jason continued to talk about the complexities of mobile transfusions, but I couldn't get my eyes off the bag of blood, and my head swam. At least I hadn't fainted.

I decided I wouldn't go into great depth, because the MC and narrator wouldn't know that much herself. Sound plausible? They might need to do it again later, I guess...

I don't see anything implausible about what you've written there (except for the previously mentioned placement of the needle). It's urban fantasy, so Vamps carrying portable blood transfusion kits probably doesn't require a whole lot of suspension of disbelief. In fact, I'd be willing to bet that someone has got there before you and written something like that already :-)

Fenika
10-21-2010, 04:13 AM
Has anyone mentioned that blood needs to be run slowly, particularly at first when you have to watch for transfusion reactions? A single transfusion takes several hours. Better to run a shock bolus of fluids, keep running fluids while you go somewhere handy to set up shop, and then pull out the right equipment and the blood.

Now, if it is literally life or death and the fluids have been running at full tilt (there are formulas for this, and as mentioned you need two large needles and lines at least), and the patient is still determined to die on you, do the transfusion and pray.

Regardless, you better be monitoring vitals 'constantly' and then steadily for the next few hours then next few days.